Medicare Pays for Your Shingles Vaccine, but the Wrong Location Can Leave You Paying First

Some vaccines are free at the pharmacy and a hassle at your doctor’s office. Here’s what to know.

There’s a Medicare detail most people never hear about until a bill arrives: vaccines are not all handled the same way.

Some shots are covered under Medicare Part B, which pays doctors. Others fall under Part D, your drug plan. That distinction can determine whether you leave the appointment owing nothing or end up paying up front.

The vaccines themselves are supposed to cost you $0. But if you get the right shot at the wrong place, you may have to pay first and seek reimbursement later.

After decades of seeing complicated systems dump paperwork on ordinary people, I can tell you this one is manageable once you know the rule. Here’s how it works.

1. These shots are covered by Part B

Part B covers four preventive vaccines, along with the cost of administering them, according to the Centers for Medicare & Medicaid Services’ guide for providers: flu, pneumococcal (pneumonia), COVID-19 and hepatitis B for people at intermediate or high risk.

There is one important condition. Medicare.gov says a flu shot, pneumonia shot or COVID-19 shot costs $0 only when the provider accepts assignment — meaning the provider accepts Medicare’s approved amount as payment in full.

Do not assume. It is worth asking a quick question before you roll up your sleeve: “Do you accept Medicare assignment?”

For the COVID-19 shot, Medicare.gov also says to bring your Medicare card so the provider can bill Medicare.

2. These shots are covered by Part D

Here’s the twist. CMS classifies the shingles, RSV (respiratory syncytial virus) and Tdap (tetanus, diphtheria and whooping cough) vaccines as Part D shots. That means your drug plan pays instead of Part B.

Medicare.gov says these Part D vaccines cost $0, with no copay and no deductible, as long as the federal vaccine advisory committee recommends the shot.

That $0 rule is relatively new. According to the Department of Health and Human Services, the 2022 Inflation Reduction Act eliminated copays and deductibles for recommended Part D vaccines in January 2023.

If your drug coverage comes through a Medicare Advantage plan, Medicare.gov says it also covers shots such as RSV.

3. The doctor’s office catch

This is where the system catches people off guard.

Part D plans do not have doctor networks. CMS says Part D networks include pharmacies only. So if your doctor gives you a Part D vaccine in the exam room, CMS treats that as out of network.

The result is that you may be asked to pay the administration fee — the charge for giving the shot, not for the vaccine itself — before you leave. After that, you must ask your Part D plan for reimbursement.

To be clear, CMS says Part D enrollees ultimately owe nothing for these recommended vaccines. The inconvenience is fronting the money, filing a claim and waiting for repayment. CMS says your doctor may help file the claim, but you should not count on it.

4. Where to get each shot for $0

The easiest approach is to get your Part D shots at a pharmacy in your drug plan’s network. That is the setting the system is built around.

Medicare.gov lists both your local pharmacy and your doctor’s office as places to get the RSV vaccine.

A good rule of thumb is to use the pharmacy first for shingles, RSV and Tdap, and to bring both your drug plan card and your Medicare card so the pharmacy can bill the correct plan.

One caveat with RSV, shingles and Tdap: pharmacy rules can differ by state, so call ahead to make sure your pharmacy can administer them without a prescription.

If you are unsure whether you need these vaccines, the Centers for Disease Control and Prevention recommends a single RSV dose for everyone 75 and older and for adults 50 to 74 who are at higher risk of severe illness. It is not currently an annual vaccine.

For the others, check what doctors recommend at 50, 65 and 75, and ask your own physician.

Part B shots are more flexible. Your doctor’s office or a pharmacy can work, as long as the provider accepts assignment. At some stores, your free flu shot may even come with a reward.

5. No Part D? Here’s what these shots cost

This is where the price can become very real. Nonprofit KFF estimates that about 1 in 9 Medicare enrollees — roughly 11% — do not have drug coverage at least as strong as Part D. If that applies to you, the $0 Part D benefit does not apply, and original Medicare’s Part B does not cover routine shingles, RSV or Tdap shots.

So what might you pay? The CDC’s adult vaccine price list shows a private-sector price of about $243 per dose for Shingrix, the shingles vaccine. Since the CDC says adults need two doses, that comes to roughly $485. RSV vaccines are listed at about $319 to $321 per dose.

Keep in mind these are provider prices, not necessarily what you will see at the register, and they do not include the administration fee. Always ask for the full cost before you schedule.

If you pay out of pocket for prescriptions, it may be worth comparing prices in a prescription savings center.

The bottom line

The vaccines are not the expensive part. The confusion is.

Get flu, pneumonia and COVID shots wherever the provider accepts assignment. Get shingles, RSV and Tdap at an in-network pharmacy. And if you do not have drug coverage, find out the price before anyone picks up a needle.

Medicare covers plenty of preventive care at no cost. Here are 13 things that are free with Medicare worth knowing about.