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.