About 1 out of every 3 people in the United States will develop shingles in their lifetime, the Centers for Disease Control and Prevention (CDC) estimates.
Shingles, a reactivation of the chickenpox virus, typically causes a painful, itchy rash on a person’s body that can linger for months or even years. Anyone who has ever had chickenpox can get shingles, including children, but people who are older or those with weakened immune systems are at increased risk.
In a 2019 report to Congress, the Medicare Payment Advisory Commission found that the shingles vaccine’s cost – which can be more than $400 for the required two doses if a Medicare recipient hasn’t met their deductible – “may pose a barrier to vaccination.”
VERIFY reader Patricia recently texted the team to ask whether Medicare will start paying for the shingles vaccine in 2023.
Is the shingles vaccine free for Medicare recipients in 2023?
- The Inflation Reduction Act
- The Centers for Medicare and Medicaid Services
- Humana, a for-profit health insurance company
- The Kaiser Family Foundation
- Mary Johnson, Social Security and Medicare policy analyst for the Senior Citizens League
Yes, the shingles vaccine is free for Medicare recipients in 2023, if they have purchased optional Part D prescription drug coverage from a private insurance company.
Many Medicare Advantage plans offered by private companies also include Part D coverage.
WHAT WE FOUND
The shingles vaccine isn't guaranteed to be free for all Medicare recipients. The cost is dependent upon your plan, the type of vaccine you get and the place you receive the shot, according to insurance company Humana.
Most Medicare plans offering prescription drug coverage used to require a copayment for the vaccine that could vary widely in cost based on your plan. People with Medicare drug coverage may have also had to pay the full price for a shingles vaccine if they hadn't met their deductible for the year, Humana explains.
But that changed beginning January 2023 because of the Inflation Reduction Act.
Medicare is federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions. It’s made up of four parts: A, B, C and D. You can read more about what’s covered under each part here.
Medicare Part D, which is voluntary, provides coverage for prescription drugs and immunizations. People on Medicare can purchase Part D coverage from a private insurance company or it may be included as part of Medicare Advantage plans (Part C) offered by private companies.
Part A and B alone don’t cover all prescriptions and vaccinations.
The Inflation Reduction Act, which Congress passed in 2022, includes prescription drug and vaccine provisions that impact Medicare Part D recipients.
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One of those provisions requires insurance companies that offer Medicare Part D prescription drug coverage to fully cover the cost of adult vaccines recommended by the CDC Advisory Committee on Immunization Practices (ACIP) starting Jan. 1, 2023. That includes the shingles vaccine.
This means people with Medicare Part D will “pay nothing out-of-pocket” for the shingles vaccine and others recommended by ACIP, the Centers for Medicare and Medicaid Services says in a fact sheet about the Inflation Reduction Act.
The Kaiser Family Foundation notes that about 1 in 4 Medicare recipients do not have the optional prescription drug coverage, meaning they wouldn’t receive the prescription and vaccine-related benefit changes included in the Inflation Reduction Act.
Those who meet certain income requirements can receive help paying for Medicare Part D through the government’s “Extra Help” program.
People who are uninsured may also be able to receive free or low-cost vaccines through their state health department or a community health center.