Shingrix Cost on Medicare

Navigating the Shingrix cost on Medicare just got easier. Due to changes like the Inflation Reduction Act, Medicare Part D now covers the Shingrix vaccine at $0 out-of-pocket for those enrolled.

Explore the nuances of how Medicare Parts D and Medicare Advantage affect your coverage, and learn what you need to maximize your benefits without any surprise costs for the Shingrix vaccine.

 

Key Takeaways

  • Medicare Part D now covers 100% of the cost for the Shingrix vaccine and other ACIP-endorsed vaccines, eliminating out-of-pocket expenses for enrollees.

 

  • The Inflation Reduction Act has resulted in substantial savings for seniors on Medicare, with the potential to save around $400 on the complete course of the Shingrix vaccine.

 

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Navigating Shingrix Coverage and Costs with Medicare

Gaining insight into Medicare’s coverage for the Shingrix vaccine could assist in healthcare planning. Medicare offers extensive coverage for the Shingrix vaccine under its Part D prescription drug plans. This means you can get the vaccine at little to no cost, depending on your specific plan.

Medicare Advantage plans, an alternative to Original Medicare, have provisions to cover Shingrix costs as well. These plans combine Parts A and B and often include prescription drug coverage (Part D). However, the specifics of the coverage, including cost-sharing and network restrictions, can vary by plan.

 

Navigating Shingrix Coverage and Costs with Medicare

Zero Cost-Sharing for Shingrix Under Medicare Part D

From 2024 onwards, beneficiaries experience zero cost-sharing as Medicare Part D covers the entire cost of the Shingrix vaccine. This means that you won’t have to pay any out-of-pocket costs for the vaccine if you’re enrolled in a Part D plan.

The Inflation Reduction Act has broadened the scope of Medicare Part D coverage to encapsulate all ACIP-endorsed vaccines, leading to this change. As such, it’s not just Shingrix – other vaccines are also covered under Part D, making disease control more accessible.

 

The Role of Medicare Advantage in Shingles Vaccination

Medicare Advantage (Part C) plans, such as Medicare Advantage HMO, are another option for getting coverage for the Shingrix vaccine. These plans consolidate Part A (hospital insurance) and Part B (medical insurance) into a single plan, offering more comprehensive coverage than Original Medicare.

Typically, Medicare Advantage plans cover Shingrix and other vaccines via their prescription drug coverage, also known as Part D. As a result, beneficiaries often have no additional out-of-pocket costs for these vaccines, including Shingrix.

However, the specifics of coverage can vary based on the individual plan, so it’s crucial to check with your plan provider to understand if Medicare cover the shingles vaccine for you.

 

Understanding Your Prescription Drug Plan’s Impact

Your prescription drug plan significantly influences your Shingrix vaccine coverage. Generally, prescription drug plans, whether through Medicare Part D or a Medicare Advantage plan, provide coverage for the Shingrix vaccine.

 

Free shingles vaccine for seniors

 

 

This means that you might not have any out-of-pocket expenses for the vaccine. In fact, under Medicare Part D, the cost of the Shingrix vaccine could be $0 per dose. This can significantly reduce your healthcare costs, making preventative care more accessible and affordable.

The Financial Benefits of Shingrix on Medicare

Obtaining the Shingrix vaccine via Medicare offers substantial economic advantages. For starters, the cost of the vaccine is substantially lower for Medicare beneficiaries compared to those without coverage.

In fact, due to changes under Medicare Part D, seniors can potentially save around $400 on the complete course of the Shingrix vaccine. This is because there are generally no out-of-pocket expenses for the vaccine for those with Medicare prescription drug coverage.

 

Comparing Costs: With and Without Medicare Coverage

The price tag for the Shingrix vaccine can be considerably high without Medicare coverage. The typical cost of Shingrix without Medicare is around $250 per dose, resulting in a total cost of about $500 for the full course.

On the other hand, Medicare coverage considerably lowers the Shingrix cost. In many cases, the cost for Medicare beneficiaries is $0, as most prescription drug plans under Medicare cover the entire cost of the vaccine.

This demonstrates the substantial savings that Medicare coverage can offer when it comes to preventative healthcare.

 

Savings for Seniors: Shingrix Vaccine at No Extra Charge

From 2024, seniors enrolled in Medicare prescription drug plans can avail Shingrix vaccine at no additional cost. This is a result of the Inflation Reduction Act, which has removed cost-sharing for recommended vaccines under Medicare Part D.

 

Does medicare cover shingles vaccine in 2024

 

 

Without Medicare coverage, seniors would have to pay the full list price for the Shingrix vaccine, which is around $183.41 per dose, or $366.82 for both doses. With Medicare, however, seniors can save over $400 on the complete course of the Shingrix vaccine, making preventative care more affordable.

How to Access Shingrix Through Medicare

The process to get the Shingrix vaccine via Medicare is quite simple. First, ensure that you have prescription drug coverage, either through Medicare Part D or a Medicare Advantage plan that includes prescription drug benefits.

Next, you need to find a healthcare provider that offers the Shingrix vaccine and can bill under Medicare Part D. Most Medicare Part D enrollees receive the Shingrix vaccine at a pharmacy, but you can also use the SHINGRIX locator tool to find providers near you.

 

Finding a Provider for Shingrix Vaccinations

Locating a Shingrix vaccination provider is uncomplicated. You can use the SHINGRIX locator tool on the official website, or refer to the CDC’s dedicated website for shingles vaccination to find provider information.

 

Free shingles vaccine for seniors 2024

 

 

While many primary care physicians can administer the Shingrix vaccine, not all doctor’s offices can bill for vaccinations for Part D enrollees. If you prefer to receive the vaccine at your doctor’s office, make sure to inquire about their ability to bill Part D prior to your vaccination.

 

Scheduling Your Shingles Vaccination

After identifying a provider, the subsequent step is to book your Shingrix vaccination appointment. This can be done through various insurance plans, including Medicare.

It’s worth noting that the Shingrix vaccine is given in two doses, with an advised interval of 2 to 6 months between doses. Also, you can receive the Shingrix vaccine at the same time as other vaccines, making it convenient if you need to catch up on other immunizations.

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Additional Vaccine Coverage Under Medicare

Besides Shingrix, Medicare also covers an extensive array of other vaccines. Most vaccines are covered at no cost under the Medicare Part D drug plan, making preventative healthcare more accessible for beneficiaries.

This includes the following vaccines that Medicare covers:

 

  • Flu shot (covered by Medicare Part B)
  • Additional flu shots (covered if deemed medically necessary)
  • Pneumococcal vaccine
  • Hepatitis B vaccine

 

Full Spectrum of Vaccines Covered by Medicare

Medicare offers coverage for an exhaustive roster of vaccines, including:

 

  • The flu vaccine
  • The pneumococcal vaccine
  • The COVID-19 vaccine
  • The hepatitis B vaccine
  • The Tdap vaccine
  • The RSV vaccine
  • The shingles vaccine

 

It’s also important to note that the coverage for these vaccines is often provided at no cost to the beneficiary.

 

Shingrix gsk

 

 

For example, the COVID-19 vaccine is included in Medicare benefits and is provided at no cost. Similarly, Medicare Part B covers the cost of the hepatitis B vaccine for individuals at medium or high risk for the virus, also at no cost.

 

Vaccination as Preventative Health Care

Vaccination serves a vital function in preventive healthcare, particularly for the elderly. By preventing specific illnesses and bolstering the immune system, vaccines can help decrease the likelihood of serious diseases like:

 

  • flu
  • pneumonia
  • shingles
  • and others.

 

For older adults, this is particularly important. Vaccines reduce mortality rates by preventing severe infections and their related complications. This is crucial given the increased vulnerability of older adults due to age-related physiological changes.

The Shingrix vaccine, for example, offers robust protection against shingles, caused by the varicella zoster virus, and postherpetic neuralgia, which can significantly affect the quality of life for individuals aged 50 and above. It is essential to cover the shingles vaccine in discussions about preventative healthcare for older adults.

Maximizing Your Medicare Benefits for Vaccinations

Does medicare cover shingles vaccine

 

 

You can take measures to fully utilize your Medicare benefits and ensure you receive the required vaccines. This involves:

 

  • Making sure you have prescription drug coverage, as most vaccines are covered under Medicare Part D.
  • Reaching out to your healthcare provider to determine the coverage and availability of vaccines.
  • Most vaccines, including the flu, pneumococcal, and shingles vaccines, can be administered at a doctor’s office or pharmacy.
  • Staying informed about vaccine schedules by checking the Medicare website or the CDC’s resources.

Summary

In summary, the Shingrix vaccine is an essential preventative measure against shingles, particularly for older adults. With Medicare Part D or a Medicare Advantage plan, the cost of the vaccine is significantly reduced, often to $0, providing considerable savings for beneficiaries.

By understanding your Medicare benefits and how they apply to vaccinations, you can ensure you receive necessary preventive care. Remember, preventive health care is key to maintaining your overall health and wellbeing. So, stay informed, stay vaccinated, and stay healthy!

Frequently Asked Questions

 

 

How much does Shingrix cost with Medicare?

The cost of Shingrix with Medicare depends on your specific plan, but as of 2024, most beneficiaries will pay $0 due to Medicare coverage.

 

→  Will Medicare pay for Shingrix in 2025?

Yes, starting in 2024, Medicare will cover the entire cost of the shingles vaccine and other vaccines recommended by ACIP.

 

Is the Shingrix vaccine free for seniors?

Yes, the Shingrix vaccine is free for seniors under Medicare, thanks to the Inflation Reduction Act. Therefore, seniors should not have to pay anything out of pocket for this vaccination.

 

What other vaccines does Medicare cover?

Medicare covers a wide range of vaccines, including the flu vaccine, pneumococcal vaccine, COVID-19 vaccine, hepatitis B vaccine, and Tdap vaccine. You should consult with your healthcare provider to determine which vaccines are right for you.

 

How can I find a provider for the Shingrix vaccine?

You can find a provider for the Shingrix vaccine by using the SHINGRIX locator tool on the official website or referring to the CDC’s website for shingles vaccination.

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Speak with a licensed insurance agent

 1-833-641-4938
TTY 711

Mon-Fri : 8am-9pm EST

Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.