Does Medicare Cover Shingles Vaccines?

The chances are good that you or someone you know will develop shingles. According to the Centers for Disease Control and Prevention (CDC), one in three Americans will have a bout of shingles at least once.

Shingles, also known as herpes zoster, is a painful rash that occurs when the same virus that causes chickenpox reactivates in the body. Though chickenpox usually affects children, the virus remains dormant in nerve tissue after the initial infection and can reactivate years later as shingles. This reactivation often occurs in older adults or those with weakened immune systems.

Symptoms and Complications of Shingles

Shingles typically manifests as a painful rash, often on one side of the body or face. The rash could also appear as a stripe of blisters that wrap around the torso. Before the rash appears, individuals may experience pain, itching, or tingling in the affected area. Other symptoms can include fever, headache, and fatigue.

The pain associated with shingles can be severe and may persist even after the rash has healed, a condition known as postherpetic neuralgia (PHN). PHN can last for months, or even years, significantly affecting quality of life.

Shingles Vaccines

Vaccination is the most effective way to prevent shingles and its complications. The CDC recommends the Shingrix vaccine for adults aged 50 and older, as well as for adults aged 19 and older who have weakened immune systems due to disease or therapy.

Shingrix is a recombinant, nonlive vaccine given in two doses, two to six months apart. It has been shown to be more than 90 percent effective at preventing shingles and PHN. The vaccine's effectiveness does decrease over time, but it still offers significant protection even years after vaccination.

Shingrix is preferred over Zostavax, an older vaccine, because of its higher efficacy. Zostavax, a live attenuated vaccine, was used in the past but as of November 2020 is no longer available in the United States.

Medicare Coverage for Shingles Vaccines

One of the key concerns for older adults considering the shingles vaccine is whether Medicare covers the cost. The answer depends on the type of Medicare coverage an individual has.

Medicare Part A and Part B: Unfortunately, Medicare Part A (hospital insurance) and Part B (medical insurance) do not cover the shingles vaccine. These parts of Medicare primarily cover inpatient hospital care, outpatient services, and preventive services, such as flu shots and certain other vaccines, but not the shingles vaccine.

Medicare Part D: The shingles vaccine is covered under Medicare Part D, which provides prescription drug coverage. Most Medicare Part D coverage plans, including standalone Prescription Drug Plans (PDPs) and Medicare Advantage plans that include drug coverage (MA-PDs), cover the Shingrix vaccine. However, coverage details such as copayments, coinsurance, and whether a deductible applies can vary depending on the plan.

Check your specific Part D plan to understand your out-of-pocket costs for the shingles vaccine. Additionally, some Part D enrollees may qualify for assistance programs that can help reduce the cost.

Shingles Vaccines May Reduce Risk of Dementia

Reducing the risk of shingles is a good enough reason to get vaccinated, but there is now an additional upside.

Two recent studies suggest that getting vaccinated against shingles may benefit one’s memory. Some researchers believe that some kinds of herpes can hide in the brain as well as the parts of the body they usually inhabit. These viruses can become active again if the body’s immune system is weakened. The theory is that if these viruses become active in the brain, they may cause damage that promotes the development of dementia.

The two studies compare the medical records of hundreds of thousands of people who were vaccinated with either Shingrix or Zostavax and how many of them were later diagnosed with dementia compared with people who had not received a shingles vaccine.

One study found that people who received Shingrix shots had a 17 percent lower chance of being diagnosed with dementia in the six years following their vaccination. This was in comparison to people who had been inoculated with the less-effective Zostavax vaccine. The shingles vaccines did not completely eliminate the chance of developing dementia but seemed to delay the diagnosis of dementia.

The second study, which was sponsored by GlaxoSmithKline (GSK), the maker of Shingrix, found similar results. Using medical records of nearly 600,000 individuals, researchers compared dementia diagnoses in people over the age of 50 who got shingles vaccines with people who received a vaccine that protects against bacterial infections that cause pneumonia and strep throat. In the five years following being vaccinated against shingles, the people who received the Zostavax vaccine were 8 percent less likely to be diagnosed with dementia and the people who got the Shingrix vaccine were about 20 percent less likely to receive a dementia diagnosis.

Though these two studies suggest a correlation between getting vaccinated against shingles and possibly slowing the development of dementia, the connection hasn’t been proven yet. If you are over 50, talk with your primary care provider about getting vaccinated against shingles.

Learn More About Medicare and Late-Life Planning

As is typical of health insurance and health care, Medicare and its related plans have nuances. Speak with a health care professional or an experienced elder law attorney near you. They can discuss your specific situation and potential options with you.

For additional reading on Medicare and late-life planning, check out the following articles:

• What Vaccines Does Medicare Cover?
• Turning 65? What to Know About the 4 Parts of Medicare
• Medicare Advantage: An Alternative to Original Medicare
• Why Hire an Elder Law Attorney?