Medicare Coverage and the Shingrix Vaccination

Shingrix

This article was updated on February 24, 2020.

There are several vaccines that Medicare will cover, but is Shingrix one of those? If you only have Original Medicare, you do not have coverage for a Shingrix vaccination.

What is shingrix?

Shingrix is a shingles vaccination and the only one that’s been approved by the FDA in the past 10 years. The Shingrix vaccine has been proven to be 90 percent effective against shingles.

How it works

The Shingrix vaccine helps boost the body’s protection and defense against shingles. As people age, their immune system gets weaker. A lower immune system leaves you vulnerable to shingles.

What is the shingles virus?

The viral infection known as shingles causes you to break out in a painful rash that can happen anywhere on your body. 

It is caused by the same virus that causes chickenpox, the varicella-zoster virus. Years after you have had the chickenpox, the virus is inactive in your nerve tissue around your spinal cord. The virus can sometimes reactivate as shingles.

Medicare coverage

Part A and Part B of Original Medicare will not cover the costs of a shingles vaccination. However, if you are enrolled in Medicare Advantage (Part C) or a Medicare Prescription Drug Plan (Part D), you could have coverage.

Medicare Part D and Medicare Advantage plans offer coverage for almost all available vaccines. The coverage for these vaccinations includes medication and administering the shot.

In order to pay the least amount of money, you should get your vaccinations at a pharmacy that is in your plan’s network. If you are not sure which pharmacies are in your plan’s network, you can contact your Medicare Advantage or Medicare Part D plan directly for more information.

Depending on your plan, you will likely have to cover the costs of a copayment or coinsurance. Talk to your doctor about what is the best option for you.

Shingrix shortage 

The shingrix vaccine is in short supply due to how effective it is. Amesh Adalja, infectious disease doctor and senior scholar at the Johns Hopkins University Center for Health Security, says, “[Shingles] is a disease that people don’t want to experience if they can avoid it, because it is very painful. It can be debilitating, it can lead to chronic nerve damage, and it’s even been linked to increases in strokes and heart attacks.”

It is recommended that adults who are at least 50 years old get two doses of the Shingrix vaccine. The Center for Disease Control and Prevention (CDC) adjusted their age recommendation from 60 years old to 50 years old once Shingrix replaced the previous vaccine, Zostavax. The adjustment called for an increase in doses and higher demand.

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