How to Use Medicare Part D to Get the Shingles Vaccine - dummies

How to Use Medicare Part D to Get the Shingles Vaccine

By Patricia Barry

Copyright © 2015 AARP. All rights reserved.

Most common vaccines are covered under Medicare Part B. In other words, you get them in a doctor’s office, the doctor bills Medicare, and — in the case of flu, pneumonia, and hepatitis B shots — Medicare picks up the full tab. But shots for shingles aren’t free, and they’re covered only through Part D.

This quirk means that to get Medicare coverage for the shingles vaccine you must be enrolled in a Part D plan (a stand-alone drug plan or a Medicare Advantage health plan that covers drugs), get the shot through the plan, and pay whatever share of the cost your plan requires.

Under Medicare rules, all Part D plans must cover this vaccine. But you do need to watch out for some pitfalls in terms of paying for the shingles shot, depending on where you receive it:

  • If you’re vaccinated at a pharmacy, make sure that location is in your plan’s pharmacy network. Otherwise, the shot will cost you more than the plan’s normal co-pay — maybe even full price. (Pharmacists in every state can be licensed to give vaccinations.)

  • If you get the shot in a doctor’s office, make sure the doctor can bill your Part D plan directly through its computer billing process or can work through a pharmacy in your plan’s network that can also bill the plan directly. Otherwise, you must pay the whole bill upfront and then claim reimbursement from your plan.

Bottom line: If you want the shingles vaccine, call your plan in advance to find out which pharmacies and doctors in your area you should use to receive the shot at the plan’s regular co-pay.