How Much Does the Shingles Vaccine Cost?

Last Updated on February 26, 2024
Written by CPA Alec Pow | Content Reviewed by CFA Alexander Popinker

Protecting yourself from the excruciating pain and potential complications of shingles is a top priority as you age. The shingles vaccine plays a vital role in safeguarding your health, but understanding the associated costs can be a maze.

In this guide, we’ll navigate the intricate landscape of shingles vaccine pricing, insurance coverage, and strategies to make this essential immunization more accessible. Get ready to unlock valuable insights that will empower you to make informed decisions about your preventive care.

How Much Does the Shingles Vaccine Cost?

The cost of the shingles vaccine can span a wide range, influenced by factors such as the specific vaccine brand, insurance coverage, and your chosen healthcare provider or pharmacy.

Without insurance, the average cost for a single dose of Shingrix, the newer and more effective vaccine, can range from $175 to $237. In contrast, Zostavax, the older live vaccine, typically costs between $223 and $279 per dose.

However, these prices can vary significantly based on location. For instance, the cost of a single dose of Shingrix at a health clinic in Los Angeles might be around $185, while the same vaccine could cost $215 at a pharmacy in New York City.

According to MedicineNet, the full price for two doses of the shingles vaccine is around $324. However, the actual cost individuals need to pay can vary based on their insurance coverage. Most individuals with private insurance pay little to nothing for both doses of the shingles vaccine.

The lowest GoodRx price for the Shingrix vaccine is about $151 for the medication only, excluding administration fees.

SingleCare writes that Shingrix costs $260 per injection without insurance. Using a SingleCare prescription discount card can reduce the cost of each shot to as little as $200, saving $100 off the full two-dose vaccination.

The Shingrix Official Website notes that SHINGRIX is now $0 for almost everyone with private insurance, and all Medicare Part D patients pay an out-of-pocket cost of $0 per dose. The cost and coverage may vary and are subject to change.

Shingles Vaccine Overview

The shingles vaccine is a powerful tool in the battle against the varicella-zoster virus (VZV), the culprit behind the debilitating shingles rash and its associated complications. Shingles is a reactivation of the same virus that causes chickenpox, lying dormant in nerve cells for decades after the initial infection.

The Dynamic Duo: Shingrix and Zostavax

Currently, there are two types of shingles vaccines available on the market:

Shingrix: Approved by the FDA in 2017, Shingrix is a recombinant vaccine that offers superior protection against shingles and its complications. It is administered in two doses, spaced 2 to 6 months apart, and is recommended for individuals aged 50 and older.

Zostavax: Approved in 2006, Zostavax is a live, attenuated vaccine that provides moderate protection against shingles. It is given in a single dose and is typically recommended for individuals aged 60 and older.

Factors that Influence Vaccine Costs

Brand Power and Efficacy

The brand and effectiveness of the vaccine can significantly impact its price tag. Shingrix, being the newer and more effective vaccine, tends to be more expensive than Zostavax. For example, while a single dose of Shingrix might cost $200 at a local pharmacy, Zostavax could be priced at around $250 for the same provider.

However, the higher upfront cost of Shingrix may be offset by its superior effectiveness in preventing shingles and related complications, potentially resulting in lower long-term healthcare costs.

Insurance Coverage and Age Requirements

Your insurance coverage and age can play a pivotal role in determining your out-of-pocket costs for the shingles vaccine. Most private insurance plans and Medicare Part D cover the vaccine for individuals aged 50 and older, with varying copays and coinsurance rates.

You might also like our articles on the cost of a flu shot, yellow fever vaccination, or rabies shot.

For example, if your private insurance plan covers 70% of the cost of Shingrix and you’re responsible for a $40 copay per dose, your total out-of-pocket cost for the two-dose series would be around $130 (assuming a $200 per-dose cost).

It’s very important to check with your healthcare provider or insurance company to understand the specific coverage details and age requirements for the shingles vaccine under your plan.

Insurance and Medicare Coverage

Medicare Part D and the Shingles Vaccine

Medicare Part D, the prescription drug coverage component of Medicare, typically covers the shingles vaccine for beneficiaries aged 50 and older. However, the specific out-of-pocket costs will depend on the individual’s Medicare Part D plan, including the deductible, copays, and coinsurance rates.

For instance, if your Medicare Part D plan has a $300 deductible and a 20% coinsurance rate, and the cost of a single dose of Shingrix is $200, you would pay the full $200 for the first dose (to meet your deductible) and then $40 (20% of $200) for the second dose, totaling $240 out-of-pocket for the complete vaccine series.

It’s essential for Medicare beneficiaries to carefully review their plan’s Explanation of Benefits (EOB) and consult with their Medicare advisor or healthcare provider to understand the coverage details and costs associated with the shingles vaccine.

Private Insurance Plans

Most private insurance plans cover the shingles vaccine as a preventive care benefit, following the Centers for Disease Control and Prevention (CDC) recommendations. However, coverage details can vary significantly between plans.

Factors such as the type of vaccine (Shingrix or Zostavax), age requirements, copays, deductibles, coinsurance rates, and in-network or out-of-network providers can all impact your out-of-pocket costs for the shingles vaccine.

For example, if your private insurance plan covers 80% of the cost of Shingrix after a $500 deductible, and the vaccine costs $200 per dose, you would need to pay the full cost of the first dose ($200) to meet your deductible. For the second dose, you would be responsible for 20% of the cost ($40), resulting in a total out-of-pocket expense of $240 for the complete vaccine series.

It’s crucial to review your health insurance plan documents or speak with a representative from your insurance company to understand the specific coverage details and associated costs for the shingles vaccine under your plan.

Out-of-Pocket Costs and Financial Assistance

Average Costs Without Insurance

For individuals without insurance coverage, the out-of-pocket costs for the shingles vaccine can be significant. As mentioned earlier, the average cost for a single dose of Shingrix ranges from $175 to $237, while Zostavax typically costs between $223 and $279 per dose.

It’s important to note that these costs can vary depending on the healthcare provider, pharmacy, or health clinic where the vaccine is administered. For example, a dose of Shingrix might cost $195 at a pharmacy in Miami, while the same dose could be priced at $225 at a health clinic in Seattle.

Assistance Programs and Discounts

To help make the shingles vaccine more accessible, several financial assistance programs and discount options are available:

• Patient Assistance Programs (PAPs): Pharmaceutical companies often offer patient assistance programs that provide free or low-cost vaccines to eligible individuals based on their income level. For example, GlaxoSmithKline (the manufacturer of Shingrix) offers a PAP that could provide the vaccine at no cost to qualifying individuals.
• Vaccination Discounts: Some pharmacies, health clinics, and healthcare providers may offer discounted rates or promotional pricing for the shingles vaccine. It’s worth checking with local providers to see if any such discounts are available in your area.
• Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs): Individuals with an HSA or FSA can use pre-tax funds to cover the cost of the shingles vaccine and associated healthcare expenses, potentially saving hundreds of dollars.

By actively exploring these options, you can significantly reduce the financial burden and make the shingles vaccine more affordable.

Your Vaccination Journey

Scheduling and Availability Considerations

The availability of the shingles vaccine can vary depending on the healthcare provider, pharmacy, or health clinic. It’s recommended to schedule your vaccination appointment in advance to ensure the vaccine is in stock and to accommodate the vaccine schedule if multiple doses are required (as is the case with Shingrix).

Some locations may have limited supplies of the vaccine, particularly during peak seasons or periods of high demand. Planning ahead can help you secure your spot and avoid unnecessary delays in getting vaccinated.

Choosing the Right Provider and Vaccine Type

When planning for your shingles vaccination, it’s crucial to consider the following factors:

• Provider Type: Consult with your primary care physician, pharmacist, or a healthcare provider at a local health department clinic to discuss the most suitable option for your vaccination. Each provider type may offer different pricing and availability options.
• Vaccine Type: Based on your age, risk factors, and personal preferences, your healthcare provider can guide you in choosing between Shingrix and Zostavax, taking into account their respective efficacy and cost differences. For example, if you’re over 60 and on a tight budget, your provider may recommend Zostavax as a more affordable option, despite its lower efficacy compared to Shingrix.
• Insurance Coverage: If you have health insurance, ensure that the provider and vaccine type you choose are covered under your plan to minimize out-of-pocket expenses. Some insurance plans may only cover certain providers or vaccine types, so it’s essential to verify this information beforehand.

By carefully considering these factors, you can make an informed decision that aligns with your specific health needs, financial circumstances, and personal preferences.

Final Words

The cost of the shingles vaccine can vary significantly based on factors such as the type of vaccine, insurance coverage, and the chosen healthcare provider or pharmacy. By understanding these factors and exploring available financial assistance programs and discounts, individuals can make informed decisions about obtaining this essential preventive vaccine.

It’s very important to have open and transparent discussions with healthcare providers, insurance companies, and pharmacists to gain a comprehensive understanding of the costs involved and to identify the most affordable and accessible options for receiving the shingles vaccine.

Remember, investing in your health today can save you from significant pain, discomfort, and potential complications down the line. Don’t let the cost deter you from safeguarding your well-being – explore all available avenues to make this life-changing vaccination a reality.

If you are considering the shingles vaccine, take the following steps:

• Check your insurance plan’s coverage details for the shingles vaccine, including copays, deductibles, and age requirements.
• Consult with your healthcare provider or pharmacist to discuss the most suitable vaccine type and provider option based on your individual health needs and financial considerations.
• Explore available financial assistance programs, discounts, and the use of pre-tax funds from Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs) to offset the costs.

By taking proactive measures and being an informed healthcare consumer, you can make the shingles vaccine more accessible and protect yourself from the debilitating effects of this viral infection.

Frequently Asked Questions

Is the shingles vaccine free for people over 50?

The shingles vaccine is generally not free for individuals over 50, but the out-of-pocket costs can be significantly reduced with insurance coverage. Most private insurance plans and Medicare Part D cover a substantial portion of the vaccine’s cost for individuals aged 50 and older.

However, copays, deductibles, and coinsurance rates may still apply, resulting in some out-of-pocket expenses for the vaccine.

Should I get the shingles vaccine at age 55?

Yes, it is recommended to get the shingles vaccine at age 55. The Centers for Disease Control and Prevention (CDC) recommends that healthy adults aged 50 and older should receive the Shingrix shingles vaccine, which is administered in two doses spaced 2 to 6 months apart. Getting vaccinated at age 55 provides protection against shingles and related complications during the years when the risk of contracting the virus increases.

Why do some doctors not recommend the shingles vaccine?

There are a few reasons why some healthcare providers may not recommend the shingles vaccine:

1. Age considerations: Some doctors may not recommend the vaccine for individuals outside the recommended age range, as the vaccine’s efficacy and safety profiles may differ for certain age groups.
2. Immunocompromised patients: Doctors may advise against the shingles vaccine for patients with weakened immune systems due to certain medical conditions or medications, as the vaccine could potentially cause adverse reactions or be less effective.
3. Perceived risks vs. benefits: In some cases, healthcare providers may assess that the potential risks of the vaccine outweigh the benefits for a particular patient based on their individual health history and risk factors.
4. Personal beliefs or concerns: Some doctors may have personal beliefs or concerns about the safety or effectiveness of the shingles vaccine that influence their recommendations.

It’s essential to have an open dialogue with your healthcare provider to understand their specific reasons for not recommending the vaccine and to discuss your individual situation and risk factors. In cases where opinions differ, it may be beneficial to seek a second opinion from another qualified healthcare professional.