If you are thinking about getting the shingles vaccine, you are probably wondering if your Medicare or Medicaid plan will cover it. Vaccines can be costly, and understanding your coverage is key to avoiding unexpected expenses. Whether you are enrolled in Medicare, Medicaid, or both, your coverage for the shingles shot depends on the specific plan you have. Let us break this down to make it clear for you.
Shingles vaccine coverage under Medicare
Medicare does cover the shingles vaccine, but only through Medicare Part D. Here is how it works:
- Medicare Part A and Part B do not cover shingles vaccines. Part A covers hospital care, and Part B handles medical services like doctor visits or preventive care, but neither includes vaccines like the shingles shot.
- Medicare Part D (drug coverage) covers the shingles vaccine. If you are enrolled in a Part D plan, you should be covered for the shingles vaccine.
- Cost considerations: Most Part D plans now offer the shingles shot with no out-of-pocket cost. This means you typically do not pay a deductible or copayment.
The shingles vaccine is part of a broader list of vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), which Medicare Part D plans are required to cover.
Shingles vaccine coverage under Medicaid
Medicaid coverage for the shingles vaccine depends on where you live, as Medicaid programs are managed at the state level.
- Medicaid for adults: Some Medicaid programs cover the shingles vaccine, especially if it is deemed medically necessary.
- Medicaid expansion: If you are in a state with Medicaid expansion, you are more likely to have coverage for preventive care like vaccines, including shingles shots.
- Dual eligibility (Medicare and Medicaid): If you qualify for both Medicare and Medicaid, Medicare will typically cover the shingles shot under Part D, and Medicaid may help with other out-of-pocket costs.
It is a good idea to check directly with your state Medicaid office to confirm coverage.
Who is eligible for the shingles vaccine
The shingles vaccine, known as Shingrix, is recommended for adults aged 50 and older. This is because the risk of developing shingles increases with age, and the vaccine can help prevent complications like postherpetic neuralgia, a condition causing severe nerve pain.
- Younger adults with weakened immune systems may also be eligible for the vaccine. Speak with your doctor to determine if you qualify.
- Most people need two doses of the Shingrix vaccine, given two to six months apart.
What to know before getting the shingles shot
Here are a few things to keep in mind before scheduling your shingles vaccine:
- Check with your plan: Verify your Medicare Part D or Medicaid coverage to understand what costs, if any, you may need to pay.
- Find a covered provider: Pharmacies and doctor’s offices that are part of your plan’s network can administer the vaccine.
- Plan for two doses: The vaccine is most effective when both doses are completed on schedule.
The shingles vaccine is an important step in protecting your health, especially as you age. Knowing how your Medicare or Medicaid plan handles coverage can save you money and simplify the process. Always check with your provider to confirm your benefits and take the time to get this important vaccine.
