Does Medicaid Cover the Shingles Vaccine?

Shingles is a painful rash caused by a reactivation of the chickenpox vaccine. The condition can also cause complications such as postherpetic neuralgia, which causes long-term nerve pain. The Centers for Disease Control and Prevention (CDC) recommends that people over 50 receive two shots of Shingrix, a vaccine that prevents shingles and associated complications. Many people want to know if Medicare covers the shingles vaccine. Below, you can find out everything you need to know about shingles vaccine coverage through Medicaid and Medicare. 

Does Medicaid Cover the Shingles Vaccine?

Medicaid covers all necessary vaccines for children and may cover certain adult vaccines. However, vaccine coverage for adults varies by state, and some states choose not to cover adult vaccines at all. You can find out whether the shingles vaccine is included in your state's Medicaid coverage by contacting your state's Medicaid office. If you're eligible for a shingles vaccine through Medicaid, you may be liable for a small copayment. 

Is Shingrix Covered by Medicaid?

Shingrix is a shingles vaccine often given to adults over 50 and younger adults with compromised immune systems. Medicaid likely covers Shingrix in the 38 states with expanded Medicaid coverage and the District of Columbia. You can find out if your state has expanded Medicaid on the Medicaid website. Medicaid is less likely to cover Shingrix in states without expanded coverage. 

If Medicaid covers the Shingrix vaccine in your state, you'll most likely need to have it at an in-network facility. The average copayment for covered beneficiaries is less than $5 per shot. 

Why Is the Shingles Vaccine Not Covered by Medicare?

Medicare Part B covers COVID-19, influenza and pneumococcal vaccines. It may also cover the Hepatitis B vaccine if your doctor thinks you are at a higher risk of contracting the disease. However, original Medicare (Parts A and B) doesn't cover the shingles vaccine, and it's unclear exactly why. 

However, you may be covered for the shingles vaccine if you purchase Medicare Part D insurance through an approved private insurer or have a Medicare Advantage Plan that includes Part D coverage. However, you'll be liable for your Part D deductible if you haven't already paid it in the year you have your shingles vaccine. Part D deductibles vary widely between providers, but there is a mandatory maximum cap of $445 as of 2021. 

The only commercially available shingles vaccines are Shingrix and Zostavax. The average cost of a Shingrix shot is around $190, so beneficiaries who haven't yet paid their deductible are likely to end up paying for the entire cost of their shingles vaccine.