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Does Medicare Cover Ozempic?

Does Medicare Cover Ozempic?

Medicare Part D covers Ozempic (semaglutide) when prescribed for type 2 diabetes management. However, Medicare does NOT cover Ozempic or other GLP-1 drugs when prescribed solely for weight loss — this remains a significant coverage gap as of 2024.

Ozempic for Diabetes: Covered

Ozempic is FDA-approved for type 2 diabetes and is covered under Medicare Part D plans that include it on their formulary. Your cost depends on your plan’s tier structure—Ozempic is typically a Tier 3 or Tier 4 medication with higher cost-sharing.

Wegovy for Weight Loss: Not Covered (Yet)

Wegovy is the same drug (semaglutide) at a higher dose, approved specifically for chronic weight management. Original Medicare and most Part D plans do not cover Wegovy because Congress has not yet authorized Medicare coverage of weight loss drugs. Some Medicare Advantage plans have begun adding obesity drug coverage, but this is still uncommon.

Mounjaro, Zepbound, and Other GLP-1 Drugs

  • Mounjaro (tirzepatide) — covered by Part D when prescribed for type 2 diabetes
  • Zepbound (tirzepatide)—same drug as Mounjaro but at obesity-approved dosage; not covered for weight loss only
  • Rybelsus (oral semaglutide) — covered for type 2 diabetes under Part D

Potential Future Coverage

There is active legislative discussion about adding obesity drug coverage to Medicare. The Treat and Reduce Obesity Act (TROA) has been introduced in Congress multiple times. As GLP-1 drugs become more widely recognized as medical treatments for obesity, coverage is expected to expand—follow Medicare.gov for updates.

Reducing Your Ozempic Costs

  • Manufacturer savings programs (NovoCare) may reduce out-of-pocket costs
  • Compare Part D plans annually at Medicare.gov—formularies and costs differ
  • Extra Help (LIS) program reduces drug costs for low-income beneficiaries

Does Medicare Cover Glasses?

Does Medicare Cover Glasses?

Original Medicare generally does NOT cover eyeglasses or contact lenses. There is one important exception: Medicare Part B covers one pair of standard eyeglasses or one set of contact lenses following cataract surgery with an intraocular lens implant.

The Post-Cataract Surgery Exception

After cataract surgery where an intraocular lens (IOL) is implanted, Medicare Part B covers:

  • One pair of standard frames with basic lenses, OR
  • One set of contact lenses

If you choose premium frames or upgraded lenses beyond the standard Medicare benefit, you pay the difference. Ask your eye doctor what Medicare will cover before selecting your frames.

Getting Eyeglass Coverage Through Medicare Advantage

Many Medicare Advantage plans include a vision benefit:

  • Routine eye exam (usually once per year)
  • Annual allowance toward frames and lenses ($100–$300 on most plans)
  • Some plans offer enhanced vision benefits with higher allowances

If eyeglass coverage is important to you, prioritize it when comparing Medicare Advantage plans.

Affordable Eyeglasses for Seniors Without Coverage

  • EyeBuyDirect, Zenni, and Warby Parker offer frames starting at $6–$30 online
  • Costco Optical — significant savings on in-store exams and glasses
  • Lions Club Recycle for Sight program — free eyeglasses for low-income seniors
  • VSP Vision Care — standalone vision insurance plans available to seniors

Does Medicare Cover Glaucoma Testing?

Does Medicare Cover Glaucoma Testing?

Yes, Medicare Part B covers glaucoma testing once every 12 months for people at high risk for glaucoma. You pay 20% of the Medicare-approved amount after your Part B deductible for the exam and dilation.

Who Qualifies for the Free Annual Glaucoma Test?

  • People with diabetes
  • People with a family history of glaucoma
  • African Americans age 50 and older
  • Hispanic Americans age 65 and older

What the Glaucoma Test Includes

  • Visual field testing (perimetry)
  • Dilated eye exam
  • Measurement of eye pressure (tonometry)
  • Examination of the optic nerve

Who Can Perform the Glaucoma Exam?

The glaucoma test must be performed by or under the direct supervision of an ophthalmologist (MD eye specialist) or optometrist who is licensed by the state to perform these services.

Treatment for Glaucoma

If glaucoma is diagnosed, Medicare covers medical treatment including:

  • Prescription eye drops (Part D)
  • Laser treatment (Part B — 80% after deductible)
  • Glaucoma surgery (Part B — 80% after deductible)
  • Follow-up monitoring visits (Part B)

Does Medicare Cover a Gym Membership in 2026? SilverSneakers & Fitness Benefits Explained

does-medicare-cover-silver-sneakers
Original Medicare: No. Medicare Parts A and B do not cover gym memberships, fitness classes, or exercise programs. Medicare Advantage: Often yes. Tens of millions of Medicare Advantage enrollees have access to free gym memberships and fitness programs like SilverSneakers, Renew Active, and Silver&Fit—included at no extra cost in their plans. The trick is knowing you have it.

Physical activity is one of the most powerful tools for healthy aging. Regular exercise reduces falls, improves cardiovascular health, slows cognitive decline, and manages dozens of chronic conditions. Medicare has recognized this by allowing Medicare Advantage plans to offer fitness benefits — and a large percentage of them do. Here’s the complete guide to what’s available, who has it, and how to access it.

Why Original Medicare Doesn’t Cover Gym Memberships

Original Medicare (Parts A and B) is designed to cover medical care—doctor visits, hospital stays, tests, and procedures. Physical fitness programs fall outside that traditional definition of medical care under the original Medicare statute. There is no legislative provision that enables Parts A and B to pay for gym memberships, fitness classes, yoga, swimming, or similar activities.

The good news is that Medicare Advantage — the private-plan alternative to Original Medicare — is specifically authorized to offer supplemental benefits beyond what Original Medicare covers, including fitness programs. This is why Medicare Advantage plans have become a major channel for senior fitness access.

The Three Major Medicare Fitness Programs

SilverSneakers

Operated by Tivity Health — available through many Medicare Advantage and Medigap plans
  • Access to 15,000+ gym and fitness locations nationwide
  • Group fitness classes designed for older adults (strength, balance, flexibility, cardio)
  • On-demand online video library with 200+ workout videos
  • SilverSneakers LIVE — live-streamed virtual classes
  • No monthly gym fees when accessed through a qualifying Medicare plan
  • Participating locations include YMCA, LA Fitness, Planet Fitness, Anytime Fitness, and thousands of local gyms

Renew Active

UnitedHealthcare’s proprietary fitness benefit — available with most UnitedHealthcare Medicare Advantage plans
  • Access to a nationwide gym network (different from SilverSneakers)
  • Brain health program through AARP Staying Sharp
  • Online fitness classes and workout videos
  • Personalized fitness plan
  • Included at no extra cost in most UHC Medicare Advantage plans

Silver & Fit

Operated by American Specialty Health — available through select Medicare Advantage plans
  • Access to 14,000+ fitness facilities
  • Home fitness kits available for members who prefer at-home exercise
  • Online exercise classes and digital fitness resources
  • Healthy aging education programs
  • Included in various Medicare Advantage plans, particularly in certain regional markets

Which Medicare Advantage Plans Include Fitness Benefits?

Most major Medicare Advantage plan sponsors include some form of fitness benefit. Here’s a general overview—specific plans and benefits vary significantly by county:

Plan SponsorFitness Benefit
UnitedHealthcareRenew Active (most plans)
HumanaSilverSneakers (most plans)
AetnaSilverSneakers or Silver&Fit (varies by plan)
BCBS plans (varies by region)SilverSneakers or Silver&Fit (varies)
Cigna-HealthSpringSilverSneakers (many plans)
AnthemSilverSneakers (many plans)
Kaiser PermanenteAccess to Kaiser’s own fitness centers and programs
Devoted HealthFitness benefits vary by market

This table is illustrative—specific benefit inclusion changes annually during plan redesign. Always confirm the fitness benefit for the specific plan you’re considering by checking the plan’s Summary of Benefits or calling the plan directly.

How to Find Out If You Already Have a Fitness Benefit

Millions of seniors are already enrolled in Medicare Advantage plans that include fitness benefits—and don’t know it. Here’s how to find out quickly:

  1. SilverSneakers eligibility check: Go to SilverSneakers.com, click “Check Your Eligibility,” and enter your name and date of birth. The tool will tell you in seconds whether your current plan includes SilverSneakers.
  2. Call your plan’s member services: Call the number on the back of your Medicare Advantage card and ask: “Does my plan include a fitness or gym benefit?” Ask for the specific program name and how to activate it.
  3. Review your Summary of Benefits: Your plan’s annual Summary of Benefits document lists all supplemental benefits, including any fitness program. Look for “fitness,” “gym,” “SilverSneakers,” “Renew Active,” or “Silver&Fit.”
  4. Check Medicare Plan Finder: At Medicare.gov/plan-compare, each plan’s listing includes a supplemental benefits section that shows whether fitness coverage is included.
Don’t assume you don’t have it: Research by Tivity Health (SilverSneakers’ parent company) found that a significant percentage of eligible members never activate their fitness benefit—often because they don’t know they have it. Taking five minutes to check could save you $400–$700 per year in gym fees.

What If Your Medicare Advantage Plan Doesn’t Include a Fitness Benefit?

If your current plan doesn’t include a fitness benefit, you have options:

  • Switch plans at Open Enrollment (Oct 15 – Dec 7): Many Medicare Advantage plans that include fitness benefits have $0 premiums. Switching to a plan that includes SilverSneakers may cost you nothing extra in premiums—and save you $400–$800/year in gym fees. Use Medicare Plan Finder to filter for plans with fitness benefits in your zip code.
  • YMCA Active Older Adults programs: Many YMCAs offer reduced-rate or free memberships for seniors on fixed incomes, independent of Medicare. Call your local Y to ask about senior rates.
  • Community center and recreation department programs: City and county parks and recreation departments often offer fitness classes specifically for seniors at low cost ($2–$5 per class or minimal annual memberships).
  • Hospital-based wellness programs: Many hospitals operate community wellness centers with subsidized rates for seniors, particularly for those who are patients of affiliated physicians.

Beyond Gym Access: Other Fitness-Related Benefits in Medicare Advantage

Some Medicare Advantage plans go beyond gym memberships to offer broader fitness and wellness benefits, including:

  • OTC (over-the-counter) benefit cards: Quarterly allowances ($25–$200) that can be used at participating retailers for health and wellness products, sometimes including exercise equipment, resistance bands, and fitness accessories.
  • Transportation to fitness facilities: Some plans include a set number of free rides per year to gyms or fitness centers through their NEMT benefit.
  • Home fitness kits: Some Silver&Fit participants can choose a home fitness kit instead of gym access—useful for members who prefer at-home exercise or live far from participating gyms.
  • Chronic condition fitness programs: Specific exercise programs for conditions like arthritis, heart disease, or diabetes — sometimes covered separately from the general fitness benefit.

Frequently Asked Questions

Can I use SilverSneakers at Planet Fitness?

Yes, Planet Fitness is a participating SilverSneakers location in many markets. Hundreds of Planet Fitness locations accept SilverSneakers. Use the SilverSneakers location finder at their website to confirm participating gyms near you.

Does SilverSneakers cover classes as well as gym access?

Yes. SilverSneakers includes access to SilverSneakers-branded group fitness classes at participating locations, as well as general gym floor access. Classes include SilverSneakers Classic (seated and standing exercise), SilverSneakers Circuit (cardio and strength), SilverSneakers Yoga, and others. Online and virtual classes are also included.

What if I’m on Original Medicare and my Medigap plan includes SilverSneakers?

Some Medigap plans offered by certain insurance companies do include SilverSneakers as an added value perk — even for people on Original Medicare. This varies significantly by Medigap insurer and plan. Call your Medigap plan’s member services to ask if your specific plan includes any fitness benefit.

Can my spouse use my Medicare fitness benefit?

No — fitness benefits through Medicare Advantage or Medigap are tied to the individual beneficiary’s enrollment. Your spouse would need their own qualifying Medicare plan to access a fitness benefit.

I enrolled in SilverSneakers but rarely use it. Should I switch to a plan without it and with other benefits instead?

If you’re not using your fitness benefit, it may be worth comparing plans during Open Enrollment to see whether a plan with different supplemental benefits (stronger dental, vision, hearing, or OTC allowance) better matches your actual needs. Medicare Plan Finder makes this comparison straightforward.

This article is for informational purposes only. Fitness benefit availability changes annually as Medicare Advantage plans redesign their supplemental offerings. Always verify specific plan benefits for the upcoming plan year during Medicare Open Enrollment. SilverSneakers, Renew Active, and Silver&Fit network and program details are subject to change by those programs’ operators.

 

Does Medicare Cover Cataract Surgery?

Does Medicare Cover Cataract Surgery?

Yes, Medicare covers cataract surgery. If you have Medicare Part B, standard cataract surgery is covered as a medically necessary outpatient procedure. You will pay 20% of the Medicare-approved amount after your Part B deductible is met.

What Medicare Part B Covers

  • The surgical procedure to remove the cataract
  • One pair of standard eyeglasses OR one set of contact lenses after surgery (this is the only time Medicare covers glasses)
  • Pre-operative and post-operative visits related to the surgery
  • Anesthesia administered during the procedure

What Medicare Does NOT Cover for Cataract Surgery

  • Premium intraocular lenses (IOLs) that correct astigmatism or presbyopia — you pay the upgrade cost out of pocket
  • Laser cataract surgery if you choose it solely for lifestyle preference (the standard technique is covered; any laser premium is your responsibility)
  • Routine eye exams before or after surgery that are unrelated to the cataract

Medicare Advantage and Cataract Surgery

Medicare Advantage (Part C) plans must cover everything Original Medicare covers, so cataract surgery is always included. Some plans may offer additional lens upgrade allowances—check your plan’s Summary of Benefits.

How Much Will You Pay?

Part B deductible$240 in 2024 (you pay this first)
Coinsurance20% of Medicare-approved amount after deductible
With MedigapA Medigap (supplement) plan often covers your 20% coinsurance

Frequently Asked Questions

Does Medicare cover both eyes?

Yes. Medicare covers cataract surgery on each eye, typically as separate procedures scheduled weeks apart.

Is there a waiting period?

No waiting period applies as long as your doctor certifies the procedure is medically necessary.

What if I want premium lenses?

Medicare will pay its standard approved amount for a basic monofocal lens. If you upgrade to a premium toric or multifocal IOL, you pay the difference. Ask your surgeon for a cost estimate before scheduling.

Does Medicare Cover CPAP Machines? 5 Things We Found Out

Does Medicare Cover CPAP Machines?

Yes, Medicare Part B covers CPAP machines and related supplies when you have been diagnosed with obstructive sleep apnea. Medicare classifies CPAP machines as durable medical equipment (DME), and you pay 20% of the Medicare-approved amount after your Part B deductible.

Requirements for Medicare to Cover Your CPAP

  • You must have a written order from a Medicare-enrolled doctor
  • A sleep study must document your diagnosis of obstructive sleep apnea
  • The supplier must be a Medicare-enrolled DME supplier
  • You must demonstrate that the CPAP therapy is helping — Medicare requires a follow-up visit within 90 days of starting CPAP therapy

The 3-Month Trial Period

Medicare initially rents the CPAP machine for a 3-month trial. If your doctor documents that CPAP therapy is helping you, Medicare continues to rent the equipment. After 13 months of continuous rental, Medicare ownership transfers to you.

What Supplies Medicare Covers

  • CPAP machine (rented, then owned after 13 months)
  • Replacement masks — typically every 3 months
  • Tubing — typically every 3 months
  • Filters — typically every month (disposable) or every 6 months (reusable)
  • Humidifier chamber — typically every 6 months
  • Chinstrap (if medically necessary)

BiPAP and Other Sleep Therapy Devices

Medicare also covers BiPAP machines and APAP (auto-adjusting) devices under the same DME rules. The clinical requirements are similar — documented sleep apnea, physician order, Medicare-enrolled supplier.

How to Ensure Coverage

  • Use only Medicare-enrolled DME suppliers (you can search at Medicare.gov)
  • Get a new prescription and updated sleep study if your equipment is more than 5 years old
  • Keep records of your usage — Medicare may request data downloads from your CPAP to confirm ongoing use

Does Medicare Cover Bariatric Surgery?

Does Medicare Cover Bariatric Surgery?

Yes, Medicare covers bariatric surgery — but only under specific conditions. You must have a BMI of 35 or higher, at least one serious obesity-related health condition, and documentation that your doctor has managed your obesity for at least 6 months without success through nonsurgical means.

Approved Bariatric Procedures Under Medicare

  • Roux-en-Y Gastric Bypass
  • Laparoscopic Adjustable Gastric Banding (Lap-Band)
  • Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
  • Sleeve Gastrectomy (gastric sleeve) — covered at facilities with approved bariatric programs

Eligibility Requirements

BMI requirement35 or higher
Co-morbid conditionMust have type 2 diabetes, hypertension, or another serious obesity-related condition
Prior treatmentAt least 6 months of physician-supervised weight loss efforts documented
Facility certificationSurgery must be performed at a Medicare-approved bariatric facility

What Medicare Pays For

  • The surgical procedure (Part A for inpatient, Part B for outpatient)
  • Pre-surgical consultations and lab work
  • Post-surgical follow-up visits
  • Nutritional counseling related to post-surgery recovery

What Is Not Covered

  • Weight loss programs not directly tied to surgical preparation
  • Weight loss medications
  • Surgery for cosmetic purposes or BMI under 35 without comorbidities

The Pre-Authorization Process

Medicare requires prior authorization for bariatric surgery at most facilities. Your bariatric surgeon’s office typically handles this, but you should confirm the facility is Medicare-certified and that all documentation is submitted before your scheduled date.

Does Medicare Cover Eye Exams?

Does Medicare Cover vision

Original Medicare has very limited eye exam coverage. Medicare Part B does NOT cover routine eye exams for glasses or contact lenses. However, Medicare does cover eye exams when related to a diagnosed eye disease or medical condition.

Eye Exams Medicare DOES Cover

  • Glaucoma screenings — annually for high-risk beneficiaries (diabetes, family history, Hispanic/Black Americans over 65)
  • Diabetic retinopathy exams — annually for people with diabetes
  • Eye exams related to macular degeneration treatment
  • Medical eye exams for cataracts, infections, or injuries

Eye Exams Medicare Does NOT Cover

  • Routine vision exams for glasses or contact lens prescriptions
  • Prescription glasses or contact lenses (with one exception: post-cataract surgery)
  • Refractive error correction

Medicare Advantage Vision Benefits

Many Medicare Advantage plans include routine vision benefits not available under Original Medicare:

  • Annual routine eye exam
  • Allowance toward glasses frames and lenses ($100–$300 typically)
  • Contact lens allowance

Vision benefits vary widely by plan and insurer. Compare plans during Medicare open enrollment (October 15 – December 7) at Medicare.gov.

Cost of Eye Exams Without Coverage

ServiceTypical cost
Comprehensive eye exam$100–$250
Contact lens fitting$50–$150 additional
Glasses (frames + lenses)$200–$600+
Glaucoma test$100–$200

Does Medicare Cover Home Health Care? 5 Things We Discovered.

does medicare cover home health care

Yes, Medicare covers home health care—but only specific types of skilled medical care, not custodial or personal care. If you meet the eligibility criteria, Medicare Part A and Part B both cover home health services at 100% (no cost-sharing for covered services), as long as you use a Medicare-certified home health agency.

What Medicare Covers

  • Skilled nursing care (wound care, IV therapy, injections, monitoring of serious illness)
  • Physical therapy
  • Occupational therapy
  • Speech-language pathology services
  • Medical social services
  • Home health aide services — only when also receiving skilled nursing or therapy

What Medicare Does NOT Cover

  • 24-hour home care or continuous custodial care
  • Personal care only (bathing, dressing, meal preparation) without skilled nursing
  • Homemaker services (cleaning, cooking, errands)
  • Meals delivered to your home

Eligibility Requirements

Homebound statusYou must be homebound—leaving home requires considerable effort
Physician’s orderA doctor must certify you need home health services and create a care plan
Skilled care needYou must need skilled nursing, PT, OT, or speech therapy
Medicare-certified agencyServices must be provided by a Medicare-certified home health agency

How Long Does Medicare Cover Home Health Care?

Medicare covers home health care for as long as you remain eligible—there is no fixed number of days. Coverage continues if your doctor certifies ongoing need every 60 days and you remain homebound and require skilled care.

Does Medicare Cover the Shingles Vaccine?

Does Medicare Cover the shingles vaccine

Short answer: Yes — but only through Medicare Part D (or a Medicare Advantage plan that includes drug coverage), and here’s the good news: it’s free.

If you’re on Medicare and wondering whether your plan will help pay for the shingles vaccine, you’re not alone. It’s one of the most commonly asked Medicare coverage questions, and there’s a fair amount of confusion around it. The short version is that Original Medicare (Parts A and B) does not cover the shingles vaccine, but Part D does — and as of 2023, you pay nothing out of pocket for it.

Let’s break it all down so you know exactly where you stand.

What Is Shingles—And Why Does the Vaccine Matter?

Shingles (herpes zoster) is a painful skin rash caused by the reactivation of the varicella-zoster virus — the same virus that causes chickenpox. If you’ve ever had chickenpox (and more than 99% of adults over 50 have), the virus is already dormant in your body. It can reactivate at any time, and your risk increases as your immune system naturally weakens with age.

The CDC estimates that about 1 in 3 people in the United States will develop shingles in their lifetime. The disease typically causes a painful, blistering rash — often described as a burning or stabbing sensation — that can last for weeks. The most common complication is postherpetic neuralgia (PHN), a long-term nerve pain that can persist for months or even years after the rash heals.

The good news: the shingles vaccine is over 90% effective at preventing shingles and PHN in healthy adults 50 and older.

The Only Shingles Vaccine Available: Shingrix

If you’ve heard of a shingles vaccine called Zostavax, know that it has been discontinued in the United States since November 2020. The current standard — and the only shingles vaccine available in the U.S. today — is Shingrix (recombinant zoster vaccine, adjuvanted, or RZV).

Shingrix is a two-dose series, with the second dose given 2 to 6 months after the first. The CDC recommends Shingrix for:

  • All immunocompetent adults 50 years and older, regardless of whether they’ve had shingles before or previously received Zostavax
  • Adults 19 years and older with weakened immune systems

No screening — verbal or lab-based — is required for prior varicella infection before getting vaccinated.

Does Medicare Part A or Part B Cover the Shingles Vaccine?

No. This is the most common point of confusion. Original Medicare — which includes Part A (hospital insurance) and Part B (medical insurance) — does not cover the shingles vaccine. It’s not classified as a Part B-covered service.

Part B does cover certain preventive vaccines, like the annual flu shot and the pneumococcal vaccine, but shingles is in a different category. That means if you only have Original Medicare without drug coverage, you’ll need to look elsewhere.

Does Medicare Part D Cover the Shingles Vaccine?

Yes — and with zero out-of-pocket cost since 2023.

Medicare Part D is the prescription drug coverage portion of Medicare, offered through private insurance plans that Medicare approves. Shingrix, as a commercially available vaccine, falls under Part D coverage.

Here’s the key update that changed everything: the Inflation Reduction Act (IRA) eliminated cost sharing and deductibles for all adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) under Medicare Part D, effective January 1, 2023.

That means if you have Part D:

  • No copayment
  • No deductible
  • You pay $0 for the shingles vaccine

This applies whether you’re in a stand-alone Part D prescription drug plan (PDP) or a Medicare Advantage plan with built-in drug coverage (MA-PD).

Does Medicare Advantage Cover the Shingles Vaccine?

Yes. If you have a Medicare Advantage (Part C) plan that includes prescription drug coverage, your plan is required to cover the shingles vaccine at no cost, just like a stand-alone Part D plan. The ACA mandates that Part D and Medicare Advantage plans cover all commercially available vaccines needed to prevent illness.

Just make sure you get the vaccine from an in-network provider or pharmacy to ensure seamless billing — more on that below.

How Much Does the Shingles Vaccine Cost Without Medicare?

Without Part D or Medicare Advantage drug coverage, the cost is significant. Each dose of Shingrix runs roughly $180 or more out of pocket, and you need two doses. That’s $360+ total for the full series.

Prior to the Inflation Reduction Act taking effect, Medicare beneficiaries with Part D were paying an average of about $76.94 out of pocket per shingles vaccination, with the program collectively spending over $234 million annually on patient cost-sharing for the vaccine. The IRA eliminated that burden entirely.

How to Get the Shingles Vaccine Covered by Medicare

Here’s what to do to make sure you don’t pay a dime:

What the Inflation Reduction Act Changed for Shingles Vaccines

Before 2023, even Medicare beneficiaries with Part D coverage often faced copayments or deductibles for the shingles vaccine. The Inflation Reduction Act, signed into law in 2022, made a sweeping change to improve vaccine access.

Starting January 1, 2023, all ACIP-recommended adult vaccines covered under Medicare Part D — including shingles, RSV, Tdap, and more — are provided at zero cost sharing and with no deductible. This change applied automatically to all Part D and Medicare Advantage plans.

Research published in JAMA found that this policy led to a significant increase in shingles vaccination rates among Medicare Part D beneficiaries. HHS data showed that over 10 million people on Medicare received a free vaccine in the first year under the new rule.

Who Should Get the Shingles Vaccine?

The CDC recommends Shingrix for:

GroupRecommendation
Adults 50+Routine — 2 doses, 2–6 months apart
Adults 19+ with weakened immune systems2 doses (shorter interval may apply)
Those who previously had ZostavaxShould still get Shingrix

Even if you’ve already had shingles, vaccination is still recommended—the disease can recur. No prior screening for varicella is needed before getting vaccinated.

Key Takeaways

  • Original Medicare (Parts A and B) does NOT cover the shingles vaccine.
  • Medicare Part D covers Shingrix at $0 as of January 1, 2023, due to the Inflation Reduction Act.
  • Medicare Advantage plans with drug coverage also cover Shingrix at no cost.
  • Zostavax is discontinued — Shingrix is the only shingles vaccine available in the U.S.
  • Get vaccinated at an in-network pharmacy or provider to ensure zero-cost billing.
  • If you only have Original Medicare, consider enrolling in a Part D plan or a Medicare Advantage plan with drug coverage during the next enrollment period.

References


1. Medicare.gov — Shingles Vaccines Coverage. https://www.medicare.gov/coverage/shingles-vaccines
2. Medicare.org — Does Medicare Cover Zostavax? https://www.medicare.org/articles/does-medicare-cover-zostavax/
3. MedicareWire — Medicare Plan Data & Resources. https://medicarewire.com/
4. U.S. Centers for Disease Control and Prevention (CDC) — Shingles Vaccination. https://www.cdc.gov/shingles/vaccines/index.html
5. U.S. Centers for Disease Control and Prevention (CDC) — Shingles Vaccine Recommendations. https://www.cdc.gov/shingles/hcp/vaccine-considerations/index.html
6. U.S. Department of Health and Human Services (ASPE) — Medicare Part D Enrollee Vaccine Use After Elimination of Cost Sharing (2023). https://aspe.hhs.gov/reports/ira-elimination-vaccine-cost-sharing-2023
7. JAMA Network — Shingles Vaccination in Medicare Part D After Inflation Reduction Act Elimination of Cost Sharing (2024). https://jamanetwork.com/journals/jama/fullarticle/2819156
8. U.S. Centers for Medicare & Medicaid Services (CMS) — MLN908764: Medicare Part D Vaccines. https://www.cms.gov/files/document/mln908764-medicare-part-d-vaccines.pdf
9. U.S. CMS Newsroom — HHS Data on Free Vaccines Under the IRA. https://www.cms.gov/newsroom/press-releases/hhs-releases-new-data-showing-over-10-million-people-medicare-received-free-vaccine-because
10. Shingrix Official Site — Cost & Coverage. https://www.shingrix.com/get-shingrix/shingles-vaccine-cost-coverage/