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

• The Shingrix vaccine is over 90% effective at preventing shingles in healthy adults over the age of 50. 
• Most private health insurance companies and Medicare Part D plans cover the shingles vaccines. Additionally, two-thirds of state Medicaid programs cover some or all of the cost. 
• For insurance, Medicaid, or Medicare Part D to cover the shingles vaccines, certain conditions must be met. 

Shingles is a viral infection characterized by a painful, 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 the Centers for Disease Control and Prevention (CDC). 

Fortunately, Shingrix, a vaccine 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 a reactivation of the varicella-zoster virus.

A person who is infected with shingles cannot pass shingles onto another person and typically the infection resolves within 10 days. 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 a burning, itching, or painful sensation. A few days later, a rash appears on either the right or left side of the face. The rash often appears in a single line.

Other possible symptoms include:

• Blisters
• Fever
• Headache
• Chills
• Upset stomach

In severe cases, people can suffer hearing 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 a few 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 a preventative 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 their recommended health screenings and preventative measures. 

If someone got their shingles vaccine before 2020, they may have received the Zostavax 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, the CDC 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 a prescription to receive Shingrix. Instead, they can show up at a local 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 a shorter immunization schedule (1–2 months later). A doctor 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 a free text reminder system. Learn more about that system here. 

Are There Any Side Effects of the Shingles Vaccine?

According to the 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. 

Some clinical trials suggest the vaccine may increase one’s risk of Guillain-Barré syndrome (GBS). GBS is a rare 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 have had:

• 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 estimates 99% 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 a healthcare 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 out these guidelines and immunization practices from the CDC and speak with their provider prior to receiving the vaccine.

According to the 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 may pay. 

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

• In-network or out-of-network
• At a doctor’s office or pharmacy 
• At a specific age 

Medicare and the Shingles Vaccine

Medicare consists of three parts:

• 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 A and B do not cover the shingles vaccine. As of 2023, all Medicare Part D plans must cover 100% of the cost for ACIP-recommended vaccines, including the shingles vaccine. 

If someone wants to use a Medicare Part D plan to cover the shingles vaccine, they should get their vaccine at a pharmacy. Most doctors’ offices are unable to bill Part D enrollees. 

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

Medicare Part D and the Shingles Vaccine

Enrolling in Medicare Part D doesn’t happen automatically. Adults over 65 must either enroll separately or find a Medicare Advantage plan that covers Part D. Medicare Advantage plans are offered by private companies and have been determined to provide a similar 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 D is covered under their plan. 

Medicaid and the Shingles Vaccine

Over 81.4 million Americans are covered by Medicaid, according to the Centers for Medicare and Medicaid Services. Like Medicare, Medicaid is a governmental health program. Unlike Medicare, it is a joint program by the federal and state governments. It is also possible to be covered by Medicare 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 per dose. 

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 a private 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 a doctor’s office or pharmacy. 

The Cost For Those Who Are Uninsured 

If someone is uninsured or has a private 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.