A Guide to the Shingles Vaccine: Who Should Get It, How It Works, Cost, & More (2024)

• The Shingrix vaccine is over 90% effective at preventing shingles in healthy adults over the ageof50.
• Most private health insurance companies and Medicare Part Dplans cover the shingles vaccines. Additionally, two-thirds of state Medicaid programs cover some or all of thecost.
• For insurance, Medicaid, or Medicare Part Dto cover the shingles vaccines, certain conditions must bemet.

Shingles is aviral infection characterized by apainful, red, blistering rash that typically occurs on one side of the body, usually over the torso or the face. Typically, it occurs in adults over the age of 50 or those with weakened immune systems, and it is related to chickenpox.

99% of Americans born before 1980 had chickenpox and are at risk of developing shingles later in life, according to estimates from theCenters for Disease Control and Prevention (CDC).

Fortunately, Shingrix, avaccine against shingles, exists. It is administered in two doses spaced two to six months apart. The cost to get Shingrix is less than $5 per dose for most eligible adults. To determine shingles vaccine costs and when to get vaccinated, continue reading.

One in three people develop herpes zoster, commonly known as shingles, in their lifetime. Typically, those affected are older. To develop shingles, someone must have already experienced chickenpox (also known as varicella-zoster virus). Shingles occurs when there is areactivation of the varicella-zoster virus.

A person who is infected with shingles cannot pass shingles onto another person and typically the infection resolves within 10days. However, people who have never had chickenpox or are not vaccinated against chickenpox can develop shingles if exposed to someone who is actively infected with shingles.

The first symptom is aburning, itching, or painful sensation. Afew days later, arash appears on either the right or left side of the face. The rash often appears in asingle line.

Other possible symptoms include:

• Blisters
• Fever
• Headache
• Chills
• Upset stomach

In severe cases, people can sufferhearing loss, vision loss, and balance issues. Some people also experience persistent pain after the rash disappears known as postherpetic neuralgia (PHN). Typically, PHN goes away within afew weeks, but it can sometimes last years after an outbreak.

Note:To learn more about the symptoms of Shingles and who’s at risk,visit this source.

While there is no cure for shingles, there is apreventative vaccine called Shingrix. When both doses of the vaccine are taken, it is 90% effective,according to the CDC. For older adults, getting this vaccine is part of theirrecommended health screenings and preventative measures.

If someone got their shingles vaccine before 2020, they may have received theZostavax vaccine instead of Shingrix. While not dangerous, this vaccine isn’t as effective and is no longer sold in the United States.

If someone got Zostavax, theCDC recommends also getting the Shingrix vaccine.

How Does the Vaccine Work?

Adults over 50 or those over 19 who are at risk don’t need aprescription to receive Shingrix. Instead, they can show up at alocal pharmacy with doses available. Doctors can also administer this vaccine.

Two to six months later, someone should receive the second dose. If someone is immunocompromised, they may benefit from ashorterimmunization schedule (1–2 months later). Adoctor should be consulted before shortening the time between shots.

Both dosages are administered as shots to the upper arm. They strengthen the immune system against the reactivation of the varicella zoster virus, which causes chickenpox and shingles.

To make it easier to schedule your doses, Shingrix offers afree text reminder system.Learn more about that system here.

Are There Any Side Effects of the Shingles Vaccine?

According tothe Shingrix website, side effects include:

• Muscle pain, especially around the injection site
• Redness, swelling, or pain at the injection site
• Fatigue
• Headache
• Fever
• Shivering

The most common complication is an allergic reaction. If someone experiences this, they may experience hives, swelling of the face or throat, trouble breathing, or dizziness.

Side effects usually disappear in two to three days. If they don’t disappear or someone experiences an allergic reaction, they should contact their doctor. For more on side effects and what to do if someone experiences severe side effects,check out this resource.

Someclinical trials suggest the vaccine may increase one’s risk of Guillain-Barré syndrome (GBS). GBS is arare condition that causes muscle weakness. In severe cases, those with GBS can experience paralysis and an inability to breathe on their own.You can learn more about this condition here.

The only way to prevent shingles is to get the vaccine. All adults over the age of 50 should get it, even if healthy. Adults over the age of 19 who have weakened immune systems may also need the vaccine but should consult their doctor before getting it.

Adults over the age of 50 should get Shingrix, even if they havehad:

• Shingles
• The chickenpox vaccine
• The Zostavax vaccine

Someone can only get shingles if they had chickenpox previously. However, chickenpox can manifest without visible symptoms. The CDC estimates99% of Americans born before 1980 contracted chickenpox, even if they didn’t have symptoms or remember the disease.

Shingles Vaccine and Immunocompromised Adults

Healthy adults over 50 should get two doses of Shingrix, administered two to six months apart. If someone is immunosuppressed or immunodeficient, they may benefit from shortening the time between doses to one to two months.

Those who should discuss the vaccine with ahealthcare provider before getting it include:

• Organ transplant or Hematopoietic cell transplant (HCT) recipients
• Cancer patients
• Those with human immunodeficiency virus (HIV)
• People with autoimmune conditions
• Those who take medications that suppress their immune system

Note:If someone may be immunocompromised, they should check outthese guidelines and immunization practices from the CDC and speak with their provider prior to receiving the vaccine.

According tothe Shingrix website, almost everyone who gets the vaccine pays $0. However, individual costs can vary. Whether you are covered by Medicare, Medicaid, private insurance or no insurance impacts how much you maypay.

The cost may also differ depending on if someone receives the vaccine:

• In-network or out-of-network
• At adoctor’s office or pharmacy
• At aspecific age

Medicare and the Shingles Vaccine

Medicare consists of threeparts:

• Medicare Part A: covers inpatient care, such as hospital visits or skilled nursing care
• Medicare Part B: coverage for preventative and outpatient visits
• Medicare Part D: optional coverage for prescription drugs

Medicare Part Aand Bdo not cover the shingles vaccine. As of 2023, allMedicare Part Dplans must cover 100% of the cost for ACIP-recommended vaccines, including the shingles vaccine.

If someone wants to use aMedicare Part Dplan to cover the shingles vaccine, they should get their vaccine at apharmacy. Most doctors’ offices are unable to bill Part Denrollees.

For more on Medicare coverage and the Shingles vaccine,visit this source.

Medicare Part Dand the Shingles Vaccine

Enrolling in Medicare Part Ddoesn’t happen automatically. Adults over 65 must either enroll separately or find aMedicare Advantage plan that covers Part D. Medicare Advantage plans are offered by private companies and have been determined to provide asimilar quality of insurance as original Medicare.

Note:not all Medicare Advantage plans cover Part D. Check with an individual Medicare Advantage provider about whether Part Dis covered under theirplan.

Medicaid and the Shingles Vaccine

Over 81.4 million Americans are covered by Medicaid, according tothe Centers for Medicare and Medicaid Services. Like Medicare, Medicaid is agovernmental health program. Unlike Medicare, it is ajoint program by the federal and state governments. It is also possible to be covered byMedicare and Medicaid.

Since Medicaid is co-run by state governments, coverage varies from state to state. About two-thirds of states and the District of Colombia currently cover the shingles vaccine for older adults with Medicaid coverage.

When the Shingrix vaccine is covered by Medicare, covered individuals can receive the vaccine in-network for $5 or less perdose.

To find out if your state provides this coverage,visit this source.

Private Health Insurance and the Shingles Vaccine

According to Shingrix, 95% of private health insurance plans cover the cost. Someone covered by aprivate health insurance plan can usually get this vaccine with zero copays or deductibles but refer to individual plans for specific costs.

To be covered, most insurance companies require the insured to get the vaccine in-network at either adoctor’s office or pharmacy.

The Cost For Those Who Are Uninsured

If someone is uninsured or has aprivate insurance plan that doesn’t cover the shingles vaccine, they may have to pay some or all costs out-of-pocket. This cost varies, depending on the prices set by the doctor’s office or pharmacy where someone gets the vaccine.

To determine the cost, contact the individual provider of the vaccine.

GSK for You also provides financial assistance for the shingles vaccine to eligible US citizens. The eligibility for their vaccine assistance program is determined by:

• The specific vaccine
• Location
• Household size
• Income
• Health insurance coverage

For more on GSK for You’s program,explore enrollment and eligibility information here.

Is there a downside to the shingles vaccine?

For most individuals, the benefits of the shingles vaccine far outweigh the cons. However, there are common side effects, including redness, pain, or swelling at the vaccine site. Those who receive this vaccine may also experience fatigue, muscle weakness, fever, headaches, or chills after receiving the vaccine. To better understand potential side effects and an individual’s likelihood for each, discuss the vaccine with a doctor.

How long does the shingles vaccine last?

Recent research suggests the shingles vaccine provides strong immunity for at least seven years. After that time, the vaccine’s protection can weaken.

What happens if you wait too long to get the second shingles shot?

If more than six months elapse between doses, the CDC doesn’t recommend restarting with the first dose. Instead, someone should get the second dose as soon as possible.

Why should someone be over 50 before they get the shingles vaccine?

As we get older, our immune system weakens, making us more susceptible to shingles. To strengthen aging immune systems, the CDC recommends the shingles vaccine to those over the age of 50, even if they are in perfect health. If someone is immunocompromised, a doctor may recommend the shingles vaccine before the age of 50.

What medications to avoid after getting the shingles vaccine?

Drugs that weaken the immune system can negatively impact the efficacy of the shingles vaccine. The CDC recommends discussing the vaccine with a healthcare professional if someone takes immunocompromising medications.