Does Medicare Cover The Shingles Vaccine For Seniors?

Drug prices have been on the rise in the United States, with the Department of Health and Human Services reporting an average increase of 15.2% from January 2022 to January 2023 alone. This is particularly taxing on those aged 65 and older, who depend on Medicare to help avoid paying these increased prices out of pocket. All of this comes at a time when the same age group is experiencing the biggest changes to social security ever made. Unfortunately, this age group is especially susceptible to potentially dangerous and painful infections, so it's vital for older Americans to receive vaccinations as a defense against them. One example of this is shingles, a painful bacterial rash caused by the​​ varicella-zoster virus. Under Medicare, however, some insured members may need to pay out of pocket.

The most common iteration of the shingles vaccine is Shingrix, which is covered under both the Medicare prescription drug plan (Part D) and the Medicare Advantage plan (Part C). Though the Advisory Committee on Immunization Practices (ACIP) recommends the elderly receive the vaccine, those under Original Medicare (Part A&B) will have to pay for it out of pocket. For those without coverage, GoodRx says the out-of-pocket cost of the two-cycle Shingrix vaccine is $400. It is important to note that, if you do get shingles, Part A&B plans limit hospital stays, so they won't cover patient hospital costs forever.

The Centers for Disease Control reports that shingles is more of an issue for people over the age of 50, as they run the risk of developing complications from the virus. While the infection is life-threatening in very few cases, the long-term effects of shingles can be profound. This is compounded when the infection presents itself around the face and eyes, as this can cause nerve and tissue damage affecting eyesight. Another complication, which becomes more common with elderly individuals, is the development of postherpetic neuralgia (PHN). This condition is characterized by long-term nerve pain at the infection site and can last for years following the development of shingles.

It is because of these complications that the ACIP recommended the vaccine and included it in Medicare Part D and some Part C plans. Importantly, to buy into these plans, seniors must first hold an original Medicare Part B plan, which currently costs Americans $185, but may change depending on one's income. This comes at a time when people are already experiencing Medicare price hikes for Part A and B Plans. The cost of adding a Part C plan varies by the specific coverage of your plan, which one can customize to include vaccine copays. The Part D plan, much like Part B, is dependent on one's income. With the passage of the "One Big Beautiful Bill" and the Republican party's position on Medicare, however, prices (and suffering) will likely continue to increase.