Free Shingles Vaccine Not Covered by All Medicare Plans: Check Yours

TL/DR –

The article is a response to a Medicare enrollee who questioned why they had to pay $200 for a shingles vaccination. It explains that while certain vaccinations are free under Medicare, others like the shingles vaccination are only free under a Medicare Part D plan, which the individual did not initially sign up for. The advice given is to enroll in a Part D plan during the open enrollment period, explaining that such a plan can cover relevant vaccinations at no cost.

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Toni was puzzled after she had to pay $200 for a shingles vaccination despite being enrolled in Medicare. Her doctor’s office explained that the vaccine could have been received for a $0 copay had she been enrolled in a Medicare Part D prescription drug plan. Toni, who had enrolled in Medicare in October but had not signed up for the prescription drug plan, was under the impression that all vaccinations were covered at no cost under Medicare.

When Toni tried to immediately enroll in a Part D plan via the Medicare website post her doctor’s visit in April, she was informed that she must wait until the fall enrollment period to sign up, according to Medicare’s Part D rule.

Understanding Medicare Part D

Indeed, Toni will need to wait for Medicare’s Open Enrollment Period, which runs from Oct. 15 to Dec. 7, to apply for a Part D plan. This period also allows for changes from Medicare to a Medicare Advantage HMO/PPO plan with prescriptions.

The $200 charge for Shingrix, a shingles vaccine approved by the FDA in 2017, was correctly applied by the doctor’s office. This vaccine is included at no cost with a Part D plan, hence why enrolling in a Part D plan when you first join Medicare is crucial.

Changes in Vaccine Coverage

As of Jan. 1, 2023, the Inflation Reduction Act eliminated all out-of-pocket costs for vaccines that the CDC’s Advisory Committee on Immunization Practices recommended for adults. However, Medicare enrollees must be part of a Medicare Part D plan to access vaccines at no cost.

The 2026 Medicare & You handbook provides more detailed explanation. It notes under “Preventive service… Shots (or vaccines)” that Part B covers flu shots, Hepatitis B shots, and Pneumococcal shots. However, it’s important to be enrolled in a Medicare Part D prescription drug plan, whether standalone or accompanied by a Medicare Supplement or a Medicare Advantage plan.

Importance of Medicare Part D Plan

As demonstrated by Toni’s experience, having the shingles shot covered with a $0 copay is a major incentive for Americans to enroll in a Medicare Part D plan when they are eligible. With such a plan, individuals can get their shingles vaccine at the pharmacy or doctor’s office. If the Medicare Part D prescription drug premium is unaffordable, individuals may qualify for Medicare’s Extra Help program, aiding people with limited income and assets in paying premiums and out-of-pocket costs for Part D drug coverage.

Medicare Coverage Explained

Under the “Important!” section on page 50, the handbook states: “Medicare Part D “generally covers all other adult immunizations (recommended by the Advisory Committee on Immunization Practices) to prevent diseases like shingles, tetanus, diphtheria, and pertussis and respiratory syncytial virus (RSV) at no cost to you.” If the shot isn’t on your plan’s drug list, the handbook advises asking for a coverage exception and consulting your doctor about which vaccines are right for you.

For more information, email your Medicare queries to info@tonisays.com or call 832-519-8664. You can also sign up for the Toni Says newsletter at www.tonisays.com to download Toni’s new Medicare 2026 First Steps guide.

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