How Do I Find Out Whether My Insurance Covers the Shingles Vaccine?


Quick Answer

The best way to determine whether your insurance covers the shingles vaccine is to contact your insurance provider directly, says the ZOSTAVAX website. Call your insurance company using the phone number provided on the back of your insurance card.

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How Do I Find Out Whether My Insurance Covers the Shingles Vaccine?
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Full Answer

If you have separate insurance cards for doctor’s visits and prescriptions, start by calling the number on the back of the card you use at your physician’s office. Ask the representative whether your insurance covers the shingles vaccine, called ZOSTAVAX. If the representative requests the CPT code for the vaccine, it is 90736 as of 2015. Also ask the representative what the cost is for the vaccine and whether you have a co-pay.

Additionally, you might want to ask whether you have a deductible and whether you have met your deductible for the year, because this can affect how much you pay for the vaccine, says ZOSTAVAX. Also check to see whether the costs is different at the doctor’s office versus at a pharmacy.

As of 2015, Medicare Part A and Medicare Part B do not cover the shingles vaccine, states the Medicare website. Medicare prescription drug plans, or Part D, however, do typically cover the vaccine. If you have Medicare Part D, ask the representative about the upfront costs of getting the vaccine and the process for being reimbursed.

The Affordable Care Act has helped make immunization more accessible and affordable by requiring insurance plans to cover vaccines, according to the U.S. Department of Health & Human Services. If you enrolled in a new family or individual health plan on or after September 23, 2010, the plan is required to cover the shingles vaccine at no cost. As of 2011, many employer plans provide vaccines recommended by the Advisory Committee on Immunization Practices, which includes the shingles vaccine, says HHS. No cost-sharing is required for these plans if the carrier gets the vaccine at an in-network provider.

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