Receiving A Shingles Shot At No Cost With Medicare

UNITED STATES—Toni: In October, I enrolled in Medicare but did not enroll in a Medicare prescription drug plan.  I went to my doctor in April for my annual physical and had to pay $200 when I received a shingles vaccination.  My doctor’s office told me that I needed to be enrolled in a Medicare Part D prescription drug plan for the shingle shot to have a $0 copay. I thought all vaccinations and immunizations are covered at no cost under Medicare.

I applied for a Part D plan on the Medicare website after leaving the doctor’s office in April and was told that I have to wait until the fall enrollment to enroll in a Part D prescription drug plan by Medicare’s Part D rule. Please explain what I need to do. Thank you, Toni. Cameron from Lubbock, Texas.

Cameron: Yes, you will have to wait until Medicare’s Open Enrollment Period which begins October 15 to December 7 to apply for a Medicare Part D plan or change from Medicare to a Medicare Advantage HMO/PPO plan with prescriptions.  Your doctor’s office was correct when you were charged the $200 per dose for Shingrix, which the FDA approved in 2017. The shingles vaccine is included at no cost with a Part D plan.

The situation that you are currently experiencing is why it is important to enroll in a Medicare Part D plan when you are first enrolled in Medicare (when turning 65 or before 65 if eligible or for those past 65 who are leaving employer group health insurance).  On January 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, but those on Medicare must be enrolled in a Medicare Part D plan to have vaccines at no cost.

On page 50 of the 2026 Medicare & You handbook under “Preventive service… Shots (or vaccines)”, this information explains what Part B covers:

-Flu shots (page 41).

-Hepatitis B shots (page 42).

-Pneumococcal shots (page 48).

Remember how important it is to enroll in a Medicare Part D stand-alone prescription drug plan, with or without a Medicare Supplement, or a Medicare Advantage plan with Part D. Having the shingles shot covered with a $0 copay is an important reason Americans should enroll in a Medicare Part D plan when eligible.

Those with a Medicare Part D plan can receive their shingles vaccine at their pharmacy or the doctor’s office. If you have trouble affording the Medicare Part D prescription drug premium, you may qualify for Medicare’s Extra Help program, that assists people with limited income and assets pay premiums and out-of-pocket costs for Part D drug coverage.

The handbook discusses how flu, hepatitis and pneumonia shots are covered under Medicare Part B not a Medicare Part D plan and explains that those on Medicare may pay nothing for the shot as long as the doctor or other health care providers accepts Medicare assignment. Always verify that your doctor is accepting Medicare assignment.

Under “Important!” on page 50, the handbook says: “Medicare Part D “generally covers all other adult immunizations (recommended by the Advisory Committee on Immunization Practices) to prevent you from diseases (like shingles, tetanus, diphtheria, and pertussis and respiratory syncytial virus (RSV)) at no cost to you.” The handbook advises you, if your shot isn’t on your plan’s drug list, to ask for a coverage exception and to talk with your doctor about which vaccines are right for you. It’s amazing how Medicare can make a simple medical issue like getting a vaccine so complicated.

Remember, with Medicare it’s what you don’t know WILL hurt you!

Email your Medicare questions to info@tonisays.com or call 832-519-8664.  Sign up for the Toni Says newsletter at www.tonisays.com to download Toni’s new Medicare 2026 First Steps guide.