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Does Aarp Cover Shingles Vaccine

Do I Need A Prescription For A Shingles Vaccine

Shingles vaccine is recommended for healthy older adults

Once you have a Medicare insurance plan that covers the shingles vaccine, youll need to find out whether a prescription is necessary. This is dependent on where you get vaccinated. You wont need a prescription if you get vaccinated at your doctors office.

Some pharmacies that provide vaccines do so under the standing order of a supervising physician. This is convenient for patients because it saves them a trip to the doctors office to acquire a prescription before receiving the vaccine. You may need to call your pharmacy to see how they handle shingles vaccine orders.

If your pharmacy requires a prescription, youll need to contact your medical provider first. They may want to see you in the office beforehand, but not always. Sometimes, the doctor may give you the shingles vaccine at your appointment.

Once you have the prescription in your possession, the remaining steps are pretty straightforward. Take the prescription to a pharmacy in your plans network to be filled. A pharmacist will administer the vaccine in their clinic area.

Its possible to save money on shingles vaccines with a SingleCare pharmacy savings card. SingleCare coupons can help uninsured or underinsured patients get shingles vaccines at a discounted price.

RELATED: Find a pharmacy near you

Medicare Coverage For Shingles Vaccine

Shingrix is not the first shingles vaccine, but it is the only one currently on the market in the United States.Instead of using a live virus,the vaccine uses a protein from the virus to trigger an immune response. It is administered in two doses two to six months apart.

This shingles vaccine has been shown to decrease the risk for shingles by 97% for people between 50 and 69 years old and by 91% for people 70 and older. It reduces complications as well. The risk for post-herpetic neuralgia goes down by 91% and 89%, respectively, in those age groups.

Because the vaccine works well, it is important to know if and when Medicare covers it.

Does Medicare Part D Cover The Shingles Vaccine

Yes, Medicare Part D is usually able to cover all of the commercially available vaccines, including the shingles vaccine. So, if you are enrolled in Medicare Part D, then you may be covered for it. Its important that you check your Medicare drug plan to learn whether it offers coverage for the shingles shot.

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Medicare Does Not Cover Shingrix But Soon It Will

Haley Hernandez, Health Reporter

The CDC recommends adults 50 years and older get two doses of the shingles vaccine called Shingrix to prevent complications from the disease.

Its more than 90% effective in preventing illness, according to the CDC. But for many people on Medicare, its unaffordable.

Despite covering preventative care, Medicare does not cover the shingles vaccine and at times charges up to $200 for the shot.

In January, that will change. The Inflation Reduction Act aims to reduce the cost of some drugs and close this barrier to good healthcare.

As of January 2023, all vaccinations that are covered under Medicare part D that are approved and recommended by the Centers for Medicare and Medicaid, and also by the CDC, will be covered without a co-pay. So, no cost sharing is going to be associated with , said Alejandra Rischan, lead benefits counselor for the Houston-Galveston area Counsel.

Rischan said the most common question she gets is why the shingles vaccine isnt covered by Medicare, but the Inflation Reduction Act is set to change that.

All these changes are kind of slowly trickling out with the information, and there are a lot of changes that are going to be coming in the next five years for folks who are on Medicare to save a little bit more money, so were really excited to see the rollout of this program, Rischan said.

Brief History Of Medicare Vaccine Coverage

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For much of the 20th century, vaccination efforts concentrated on the childhood population, resulting in the successful reduction of morbidity and mortality associated with at least nine infectious diseases.

Following the development of the first vaccines for older adults, like influenza and pneumococcal disease, Congress amended the Medicare statute throughout the 1980s to ensure beneficiary access to these new vaccines and the Hepatitis B vaccine for those beneficiaries at intermediate to high risk of contracting the disease. As it enacted these coverage requirements under Part B, Congress took care to prohibit beneficiary cost sharing so that seniors would not be discouraged from receiving vaccines.

Eventually, in 2003, Congress passed the Medicare Modernization Act, creating Medicare Part D, a prescription drug benefit for seniors. Under the MMA, implemented in 2005, Part D sponsors must cover all commercially available vaccines except those covered under Part B. This inexplicable decision to cover future vaccines under the prescription drug benefit while leaving previous vaccine coverage in Part B created a peculiar split in Medicare vaccine coverage. There is no meaningful clinical distinction between Part B and Part D vaccines that justifies the separation. The result is an unevenness of vaccine coverage and access across settings of care and population segments, which will be perpetuated as new vaccines for older adults are licensed and recommended.

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Medicare Part B Coverage For Shingles Treatment

Shingles appear as a painful rash on one side of your body. You may feel pain, itching, or tingling before the rash develops, and you may also have a fever, headache, or upset stomach. The rash turns into blisters that usually scab up within a week to 10 days.

If you believe you have shingles, its best to see a doctor right away. Prescription antiviral medications can shorten the illness and make it less severe, but they work best if you start taking them as soon as possible after the rash appears. If your pain is severe, your doctor may also prescribe pain medication or give you a corticosteroid injection.

Part B covers a visit to a doctor or urgent care center. It also covers any injections you receive at the doctors office. If you have a Medicare Supplement plan, you may not have to pay anything out of pocket to see a doctor for shingles.

If you have a Medicare Advantage plan, Part B will still cover doctor visits and injections. But youll have different costs than if you had Medicare.

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How Does Your Medicare Deductible Affect Your Vaccine Costs

The deductible amount of your Medicare plan affects how much you pay out of pocket before your insurer starts contributing to the cost of your prescription drugs. Depending on how many medications you take, the deductible could affect how much you spend on the vaccine.

Below, we’ll compare how much you’d pay for the shingles vaccine on two plans with different deductibles. In this situation, the person with the MedicareRx Walgreens plan pays less overall, even though they’re paying full price for the shingles vaccine.

Scenario: Shingrix is the only medication needed during the policy

AARP MedicareRx Walgreens
Cost of two doses of Shingrix vaccine $160 each, for a total of $320, because the deductible hasn’t been met $45 copay each, for a total of $90
Total annual cost of premiums and shingles vaccine $788 $1,122

In the example above, the AARP MedicareRx Walgreens prescription drug plan has a $455 deductible for Tier 3 drugs like the shingles vaccine. That means if you haven’t already met your deductible, you would pay full price for the vaccine, which would be $320 for two doses. The plan costs $38.60 per month for someone living in Charlotte, N.C. If the shingles vaccine is the only Tier 3, 4, or 5 drug needed during the policy year, your total annual spending would be $788.

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Does Medicare Cover Shingles Vaccines

Most health insurance companies cover shingles vaccines, and so does Medicare. However, Original Medicare coverage wont cover the vaccines. You must be enrolled in a Medicare Part D drug plan or a Medicare Advantage Plan that includes drug coverage in order to have prescription drug coverage that covers shingles vaccines. Medicare Part A or Medicare Part B , components of Original Medicare, wont cover shingles vaccines.

Other Medicare supplement plans, like Medigaps, dont cover shingles vaccines either.

You can enroll in a Medicare Part D prescription drug plan by itself, or enroll in a Medicare Advantage plan that includes Part A, B, and D coverage. Either of these options will usually cover the Shingrix vaccine.

Every Medicare Part D plan is different and copays or coinsurance may vary from plan to plan. Deductibles also may apply.

Different Medicare Part D plans classify medications and vaccinations into different tiers. What tier your plan puts shingles vaccinations into will determine your copay. The best way to determine the insurance plan thats best for you is to compare formularies to find the one that covers as many of your medications and vaccinations as possible or contact Medicare customer support.

About The Shingles Vaccine

Medicare & You: Vaccines

The Centers for Disease Control and Prevention recommends that healthy adults over the age of 50 get the shingles vaccine because it’s the only way to protect against the disease and its associated side effects. The risk of getting shingles increases as you age or if you have a weakened immune system. Always consult your doctor to find out if the shingles vaccine is right for you.

The CDC-recommended vaccine, Shingrix, is a recombinant zoster vaccine that has two doses administered within six months of each other. It’s classified as a Tier 3 drug by most insurance companies, which means it’s a brand-name pharmaceutical with a higher copayment than a Tier 1 or 2 drug.

Use the Shingrix vaccine locator to find where the shingles vaccine is being offered, and check with your Medicare Part D or Medicare Advantage provider to see which locations give you the lowest price.

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How Much Will You Pay For Shingles Vaccines

You can find the shingles vaccine on your Part D plan formulary or listing of covered medications. Check to see into which tier the vaccine falls the tier will define how much your insurer will pay and how much you will have to pay.14

If your doctors office will provide the vaccination, check to be sure they can bill your plan directly. That way, youll have only the copay. Otherwise, you may have to make the full payment upfront and file with your plan for reimbursement. Also, check to be sure that the doctors fee for administering the shot is covered as part of your plans allowable charge.13

Youll probably pay the least amount out-of-pocket by being vaccinated at a pharmacy thats within your drug plans network. But if you havent met your deductible for the year on your drug plan, you may pay full price for the vaccine.

If you havent had your shingles vaccine yet and youre selecting a Medicare Advantage plan during the Open Enrollment Period, be sure its one of the medications on whatever plan you choose.

How To Get Low

Children can receive financial assistance through the federal Vaccines for Children program. This is for kids who are:

  • Medicaid-eligible

  • American Indian or Alaska Native

The shingles vaccines manufacturer, GlaxoSmithKline, offers a patient assistance program for those without insurance who cant afford the vaccine. Your healthcare provider needs to apply for the program on your behalf.

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Medicare Shingles Vaccine Cost

The full cost of the shingles vaccine from Shingrix is $324, spread out across two shingles shots costing $162 each. If you have a prescription drug plan with Medicare, the approximate cost could be less than $50 per shot, a more than 60% discount from the full price!

While the premium of the prescription drug plan may be higher than that of a Medicare Advantage plan, the prescription drug plan will likely save you money on the vaccine in the long run.

Is The Shingles Shot Free For Seniors

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The shingles vaccine is not free for all seniors, and how much you pay depends on your Medicare Part D plan or your Medicare Advantage prescription drug benefits. Seniors who don’t have a prescription drug plan will have to pay full price for the shingles vaccine or use a cost-saving method to get the vaccine at a discounted price.

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Is The Shingles Vaccine Covered By Medicare And Can I Get It At Cvs

Because the shingles vaccine requires two doses, if you have to pay full price around $400 total it may approach the $445 maximum Part D deductible that Medicare allows for 2021.

If thats the case, you may want to consider getting your vaccine early in the year. This way you dont have to worry about your deductible resetting in a new plan year soon after meeting it. You should discuss the risks and benefits of this strategy with your healthcare provider.

As far as going to CVS Pharmacy or CVS in Target to get your shingles vaccine, this is definitely an option. You can always call ahead or go online to schedule same-day appointments, or go in on a walk-in basis at many locations.

How To Get A Shingrix Discount Without Medicare

There are a few different ways to receive a discount on the Shingrix vaccine. SingleCares prescription discount card provides instant savings on many prescription drugs, including Shingrix. Medicare recipients cannot use SingleCare and Medicare coverage together, but they can choose to use whichever offers a better deal for them. For those who dont have a Medicare plan that covers Shingrix, SingleCare can provide a discount.

GSK, the manufacturer of Shingrix, offers apatient assistance program for those who dont have insurance coverage. However, there are income guidelines and other eligibility requirements in order to qualify. Those who are enrolled in a Medicare Part D prescription drug plan may still be eligible for the program if their income falls below a certain threshold and theyve spent at least $600 on prescription medications through their plan during the current calendar year.

Lastly, you may qualify for financial assistance through a Medicare program called Extra Help. Extra Help can help Part D consumers lower their Medicare-related costs.

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Shingles Vaccinations Not Covered For Some Medicare Beneficiaries

Many readers have contacted me about health insurance and the Affordable Care Act. Here are answers to some of their questions.

Q. I have Medicare and a Plan F Medigap plan, so I should be covered for all medical needs. But in order to get the shingles vaccination, it will cost me $185. I cant pay this without using my grocery or prescription money. Its totally unfair. What can I do?

A. Shingles is a painful rash caused by a virus that can lead to long-term nerve damage called postherpetic neuralgia. All Medicare Part D prescription drug plans cover the shingles vaccine, which is recommended by the Centers for Disease Control and Prevention for people age 60 and older. But Medigap plans, which may cover the deductible and coinsurance amounts for services provided under Medicare Parts A and B , dont offer any financial help on the co-payments for vaccines and other drugs covered under Part D.

A Government Accountability Office report published in December found that seniors faced many obstacles to getting needed vaccines, including the shingles vaccine. Many physicians dont recommend or even stock the shingles vaccine, the report found. The amount that the patient pays out of pocket for that vaccine could also be a barrier, according to the report.

First, if you have Part D coverage, contact your plan to make sure the co-payment youre being quoted is accurate.

Medicare Drug Plans And The Shingles Vaccine

Addressing Adult Patientsâ Shingles Vaccine Concerns with Dr. Sandra Leal

Unlike Medicare parts A and B, which are government insurance plans that cover hospital insurance and outpatient medical insurance, respectively, Medicare drug plans are private insurance policies developed by providers that have contracts with the federal government. You might purchase such a policy if you have Original Medicare or a Medigap plan and need prescription drug coverage.

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How Long Does Shingrix Last

The Shingrix vaccine can remain effective for at least four years in most people and even longer in others. You must get the entire series to be protected against shingles, which includes two separate shots. Even if you have had the infection, getting vaccinated can still offer benefits because it may help reduce the risk of developing PHN.

Shingrix may not protect everyone, but it provides broader protection for older adults whose immune systems are declining with age or disease.

Fixing Medicare Vaccine Coverage Once And For All

Nonetheless, barriers to vaccine access remain for seniors due to the separate benefit part placement of vaccines in Part B and D. In seeming acknowledgment of the above problem, Congress acted rapidly to provide for coverage of COVID-19 vaccines without cost sharing under Part B when it passed the Coronavirus Aid, Relief, and Economic Security Act in March 2020, a full eight months before the first vaccine was authorized for emergency use.

As early as 2007 and as recent as 2021, the Medicare Payment and Access Commission recommended moving the coverage of vaccines from Part D to Part B. In the 2007 report, MedPAC foresaw the challenges stemming not only from beneficiary OOP costs under Part D, but also the challenges of physician out-of-network status under Part D. While pharmacists have long been permitted to roster bill vaccinations under Part B, easing the hurdle of split benefit part placement, physicians continue to face difficulty in offering Part D vaccines. Because they are out of network, this makes it difficult to ascertain coverage and cost sharing information. This may lead to patients paying the full cost of vaccines up front and seeking reimbursement under Part D later. This exacerbates the already burdensome financial requirements that result in lagging adult vaccine offerings in physician offices.

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