Unlike some common vaccines, like those for the flu, hepatitis B and pneumonia, shingles shots are not covered under Original Medicare Parts A or B.
Medicare coverage for the two commercially available shingles vaccines, Shingrix and Zostavax, is provided only if you are enrolled in a stand-alone Part D drug plan or a Medicare Advantage (Part C) plan that includes Part D drug coverage.
Whether your Medicare Part D is stand-alone or included in a Medicare Advantage (Part C) plan, you shouldn’t have difficulty obtaining the shingles vaccine shot.
In my complimentary Medicare 101 webinar, I encourage individuals to review several items – not just the monthly premium – before making a Plan D enrollment decision; additional items like the plan’s deductible, formulary and tier levels.
The shingles vaccines are a perfect example of why you need to look further.
Here’s why: Part D plans will require a copayment for the shingles vaccine, but that can vary widely from plan to plan.
I checked the Part D formulary for four Medicare Advantage PPO plans I represent:
1. The first plan has both Shingrix and Zostavax categorized as Tier 3
2. The second plan includes one at Tier 3 with the other at Tier 4.
3. The third plan has both vaccines as Tier 4, and…
4. The fourth PPO plan offers both at the lowest cost category Tier 1!
(The stand-alone Part D plans were all similar with both Shingrix and Zostavax included at the Tier 4 cost. One plan offers the vaccines at Tier 3.)
With the shingles vaccine costing approximately $200, the difference between your plan offering it as Tier 1 or Tier 4 medication means a sizable difference in the deductible and copay amount you would pay.
The Good Rx website offers a helpful tool where you can confirm your plan’s shingles vaccine coverage and cost you will be required to pay. (Simply enter your zip code and then select your Medicare Advantage or stand-alone Part D plan.)