Medicare Part D: Cost of the Shingles Vaccine

An article in the New York Times says that people who get Shingles are more likely to have a stroke.  There is also the risk of vision damage if a person gets Shingles near their eyes.  And a severe case of Shingles can cause nerve damage in the affected area, leaving a person with long-term pain and discomfort.

So why have only 20% of Americans over the age of 60 gotten the Shingles vaccine?

Getting a shot of Zostavax, the brand name for the vaccine, can reduce a person’s chances of getting Shingles by 50% and lowers  the chances for nerve damage even more.  But Zostavax is kind of expensive and it comes under Medicare Part D, which means it has a co-pay.  If a person’s drug plan has a deductible, as many stand-alone Part D plan do, a person might pay the full retail price.

The retail cost for Zostavax depends on which Part D plan a person has, and the range I found on Medicare.gov was from $95 for the shot to $197.  This is a one-time cost.

Part D plans have co-pays for each drug tier: generic tier 1, generic tier 2, preferred brand, non-preferred brand, and specialty drug.  But some Part D plans have a $310 deductible.

Zostavax is listed as a non-preferred brand on every Part D plan I looked at on Medicare.gov. There are 29 Part D plans available in Arizona, so I didn’t look at them all.

So what will it cost you to get the Shingles vaccine?  Well, that depends on whether or not you are enrolled in a Medicare Advantage plan with Part D included, or if you have a stand-alone Part D plan (and most likely have a Medicare supplement).

Medicare Advantage

I checked the Zostavax co-pay on several Medicare Advantage plans (CareMore, AARP Medicare Complete, Heatlh Net, and Humana). They all list Zostavax as a non-preferred brand drug with a co-pay of $95.

Stand-alone Part D

People who have stuck with Original Medicare have a stand-alone Part D plan, and most of the lower-cost plans have a $310 deductible.  So if you haven’t yet met your deductible, you will probably pay the full retail cost that was negotiated by your Part D plan, which could be around $200.

So cost is probably the main reason only 20% of seniors have gotten the Shingles vaccine.  I had a mild case of Shingles a few months ago and I am definitely going to get the vaccine now. That mild case was scary, painful, and left me with nerve damage.  I sure don’t want to get a bad case of the Shingles, so I will pay whatever it costs for the vaccine.

I have written about a client and her husband who paid very different amount for their Shingles vaccine because they had different Part D plans: Part D Deductible Explained.

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7 Responses to "Medicare Part D: Cost of the Shingles Vaccine"

  1. Rebecca says:

    I, too, am amazed at the cost – I have Humana Medicare Advantage here in the Roanoke, VA area, I have been advised over and over to get the shot – and I will have to pay $95 out of pocket. This is horrible. So that is the major reason I have NOT gotten the shot yet. If some kind person wants to pay it for me, I’ll go get it right now, but until they lower the cost, I’ll take my chances.

  2. Donna Tylkowski says:

    I have Medicare D stand alone and have not met deductible. I went on line and found coupons which says save up to 75%on Zostavax. Can I use this coupon for the shot since I do have Medicare D . and have not deductible. Thank you.

  3. Lee Martin says:

    This vacine has been available for several years now. Why is there still a high co-pay?

  4. Marilyn Bates-Gentile says:

    I have my Part D through Blue Cross Medex plan and was told by my pharmacy that my co-pay would be around $250.00! So, I will take my chances and hope I don’t get shingles. I think it is totally ridiculous that there is ANY co-pay for preventative medicine vaccines. If the government allows mothers and children on welfare to have free preventative vaccines, it is only fair that those of us who have worked our whole lives and put money into the system be allowed the same privilege..

  5. rebecca gentry says:

    I totally agree! I am STILL working, at 69+, and can’t afford it. If I don’t work I won’t survive.

  6. Steve R says:

    Walmart Pharmacy quoted, and I am with crooked Humana, $230 copay. I am well over 65.

  7. Michelle E says:

    I work for a physician that wanted to give the vaccine in our office. Our discounted COST of the vaccine was quoted as $218.66 + tax + delivery fee. The manufacturer still has the cost set extremely high, even though this vaccine has been out for several years. So the cost of the vaccine alone is what is driving your copay/coinsurance, etc. so high.

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