Is the shingles vaccine covered under my insurance plan?

Infectious Diseases Vaccines

Very likely yes. The shingles vaccine is $0 cost to people who have Medicare part D and most private insurance.

For most people who have health insurance, the shingles vaccine is available at no cost, even if you haven’t met your deductible for the year. You have to meet the eligibility requirements laid out by the CDC: age of 50+ OR 19+ with a weakened immune system.

For people with Medicare, this is a recent change. The Inflation Reduction Act went into effect in 2023, which changed how vaccines are covered under Medicare Part D. It used to be the case that you had to share the cost of some vaccines. Now, vaccines recommended by the CDC (including Shingrix) are no cost for people with a Medicare Part D prescription drug plan.

If you have an ACA or private insurance plan, Shingrix was added to the list of vaccines covered at no cost in 2022. ACA plans are sometimes called Affordable Care Act, Obamacare, Health Insurance Marketplace, or just marketplace plans. On these plans, you often need to see a provider in your network to take advantage of no-cost preventive care.

If you have Medicaid, it depends on your state. If you live in one of the many states that adopted the Medicaid expansion as part of the Affordable Care Act, then Shingrix is covered, and you’ll pay a very low cost-share (about $5 per dose).

In states that did not adopt the Medicaid expansion (TX, FL, MI, AL, GA, SC, TN, KS, WY, WI), Shingrix is likely not covered. In those states, you may pay retail prices for the Shingrix shot–about $215 per dose, according to GoodRx’s cost comparisons.

Stay safe, and stay well.

Those Nerdy Girls