Monday, July 15, 2024

Does Aetna Cover Shingles Vaccine

When Can I Sign Up For One Of Aetnas Medicare Advantageprescription Drug Plans

Shingles Vaccine

You can sign up for one of Aetnas Medicare Advantage Prescription Drug plans during your Medicare Initial Enrollment Period . For most people, your IEP begins three months before the month you turn 65, includes your birthday month, and ends three months after your birthday month.

If you already have prescription drug coverage through another insurer, or you didnt sign up during your IEP, you can switch to an Aetna Medicare Advantage Prescription Drug plan during the Annual Enrollment Period . The AEP begins each year on October 15 and ends on December 7. There may be other opportunities to sign up for, or switch to, an Aetna Medicare Advantage plan.

How can you find an Aetna Medicare Advantage plan near you? Start by typing your ZIP code where shown this page.

The formulary may change at any time. You will receive notice when necessary See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

Vaccines Covered By Medicare Part B

Medicare Part B covers three important vaccines as part of its preventive care benefits.

Covered vaccines include the following:

  • Flu vaccine: Annual vaccine given in one shot before or during flu season, usually November through April
  • Pneumonia vaccine: One-time vaccine given in two shots at least one year apart
  • Hepatitis B vaccine: One-time vaccine given in two to four shots over one to six months for people who are medium to high risk, including people with diabetes

Part B also covers vaccines you may need if youre exposed to a harmful virus or bacteria by accident. You might need a tetanus shot, for example, if you step on a rusty nail. Or you may need rabies shots if youre bitten by a stray dog.

Other Preventive Care Covered By Aetna Medicare Advantage Plans

Aetna Medicare Advantage plans can cover a range of additional benefits for preventive care. Coverage can vary, but some Aetna plans may cover:

  • Annual wellness visits
  • Various screenings and tests for a range of conditions including cancer, cardiovascular disease, depression, diabetes and much more
  • Tobacco cessation counseling

Also Check: Is Tylenol Or Advil Better For Shingles Pain

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.

How Can You Save On The Cost Of The Shingles Vaccine

Is Shingrix Covered By Medicare B

These five tips can help you pay less for a shingles vaccine.

  • Visit an in-network pharmacy with a prescription: If you have a prescription drug plan, you could pay less for your vaccine by having it administered at an in-network pharmacy. Getting the shot at a doctor’s office may lead to an additional doctor’s fee for administering the vaccine.
  • Sign up for Medicare Part D or improve your drug coverage: During open enrollment, you can select a prescription drug plan that covers Tier 3 drugs, including Shingrix. Remember to consider the total policy costs for all of your prescriptions. Also, if you receive a low-income subsidy, Medicare Part D plans could be available for free.
  • Get a discount coupon for the shingles vaccine: Pharmaceutical retailers and networks may offer vaccine discounts. Usually, you’ll present the coupon or the drug discount card at the pharmacy to get the savings.
  • Use a state pharmaceutical assistance program: A state program may be available to help you reduce the cost of prescription drugs including the shingles vaccine.
  • Get assistance from the vaccine maker: GlaxoSmithKline offers the GSK Patient Assistance Program for those who meet certain criteria. You may qualify if you earn less than $32,200 annually.
  • Don’t Miss: How Much Are Solar Panel Shingles

    When Does Aetna Medicare Pay For Flu Shots

    Flu shots are covered by Medicare Part B, and all Medicare Advantage plans are required by law to cover everything covered by Medicare Part A and Part B. Therefore, all Aetna Medicare Advantage plans cover flu shots.

    Furthermore, you wont face any out-of-pocket costs for your flu shot when you receive it from a participating network provider. Flu shots fall into the category of preventive care under the Affordable Care Act .

    For those on Original Medicare, the flu shot is free when administered by a health care provider who accepts Medicare assignment. If you have an Aetna Medicare Advantage plan, you can get a flu shot with no costs to meet that go towards deductibles or cost-sharing when provided by an Aetna health care provider.

    Is The Shingles Shot Free For Seniors

    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.

    Don’t Miss: How Soon After Having Shingles Can You Get The Vaccine

    Vaccines And Preventable Diseases

    Aetna Better Health Premier Plan provides services to help men and women live happy, healthy lives, while being aware of the preventive measures they should be taking.

    At any age, talk to your PCP if you have risk factors or symptoms. You may need to be tested earlier than the recommended age for some conditions. And remember, there are still immunizations that you need to receive:

    • Tetanus-Diphtheria or Tetanus, Diphtheria and Pertussis vaccine is needed every 10 years.
    • Influenza vaccine should be received regularly starting at age 50 prior to 50, discuss with your PCP.
    • Pneumococcal vaccine is for adults 19 years of age or older with certain medical conditions, and who have not previously received the pneumococcal vaccine. Talk to your PCP to see if you should receive the vaccine.

    Regular checkups are important to be healthy. Remember to eat nutritious foods, be active, maintain a healthy weight, avoid smoking and drink alcohol in moderation .

    How Much Do Aetnas Medicare Advantageprescription Drug Plans Cost

    Dr. Sandra Lealâs Shingles Vaccine Recommendation to Diabetic Adults

    Aetnas Medicare Advantage prescription drug plans may come with monthly premiums and other out-of-pocket costs, like deductibles, copayments, and coinsurance. Of course, this is true of any insurance company that contracts with Medicare to deliver benefits to members. These costs may vary among plans.

    Plan premiums may depend on various factors, like where you live, and the type of plan you choose.

    One thing to keep in mind: If you want Medicare prescription drug coverage, you may want to enroll under Part D as soon as youre eligible, unless you have creditable prescription drug coverage from another source, such as an employer plan. If you dont, you may have to pay a Part D late enrollment penalty based on the number of months you went without prescription drug coverage. You pay this penalty as long as you have creditable prescription drug coverage, so it can really add up over time.

    You May Like: What Can I Do For Shingles Nerve Pain

    Whats Shingrix Zostavax And Shingles

    FDA approved in 2017, Shingrix is the leading preventive tool against shingles . Shingles is caused by a once dormant chickenpox virus rearing its ugly head to give you a painful rash that can last for up to four weeks. For some, long-term pain continues even after the rash is gone, a condition known as postherpetic neuralgia.

    Since 99% of people in the US have chicken pox by age 40, and since the risk of shingles increases with age, the Centers for Disease Control recommends that every healthy adult over 50 get Shingrix.1 Shingrix is over 90% effective at preventing shingles and postherpetic neuralgia, making it the preferred shingles shot.2 But for those who may be allergic to Shingrix, another shingles vaccine, Zostavax, can be used.

    Zostavax may also be covered by Medicare prescription drug insurance , but again, you should check to be sure.

    Do I Have To Pay For Vaccines With Medicare

    You pay nothing for vaccines covered by Part B flu, pneumonia and Hepatitis B as long as your provider accepts Medicare.

    Your cost for vaccines covered by Part D will depend on your specific plan. You may pay a copay or coinsurance, but it will depend on your plan and the provider.

    The location where you get vaccinated may also affect your cost. For example, your costs may be lower if you get a vaccine at a pharmacy versus in a doctors office.

    Recommended Reading: Can Shingles Last For Months

    Where To Get Vaccinated

    You have a choice on where to get vaccinated.

    In your doctors office: You can get vaccinated in your doctors office. If the office is set up to bill Part D directly for your vaccination, you may only have to pay a copay at the time of your shingles shot. If not, you may have to pay all costs upfront and submit a claim to your Part D plan for reimbursement.

    At your local pharmacy: You can go to your local pharmacy to get your shingles shot as long as they offer the vaccine and appropriately trained staff members administer it. The rules for pharmacy vaccination vary by state. You will likely need to pay for the vaccination upfront. Pharmacies are not legally required to dispense medications without payment.

    Vaccines Covered By Medicare Part D

    Advance Walkin Clinic &  Urgent Care

    Medicare Part D covers all commercially available vaccines needed to prevent illness. You can get Part D coverage through a stand-alone Medicare prescription drug plan or a Medicare Advantage plan that includes drug coverage.

    Vaccines covered by Part D include the following:

    • Shingles vaccine: One-time vaccine given in two shots over two to six months
    • Tdap vaccine : One shot if youve never been vaccinated, and a booster every ten years
    • Other vaccines covered: Vaccines that are “reasonable and necessary” to prevent illness and are not covered by Part B

    Part D may also cover vaccines you may need if you are traveling internationally. Talk with your doctor about your travel plans and ask what vaccines are recommended.

    Recommended Reading: Does L Lysine Help With Shingles

    Can You Get The Shingles Vaccine For Free

    The shingles vaccine is manufactured by GlaxoSmithKline Biologicals, a pharmaceutical company. GSK has a patient assistance program that may provide the vaccine to you at no cost if you meet these eligibility criteria:

    • You dont have prescription drug coverage or a Part D plan and have spent at least $600 during the calendar year.
    • You are an adult, 19 or older.
    • You live in the U.S., Puerto Rico, or the District of Columbia.
    • You dont qualify for Puerto Ricos Government Health Plan.
    • Your maximum monthly gross income does not exceed certain limits, depending on where you reside and your household size.
    • You apply through your health care provider, who will register for the patient assistance program and submit your application.

    Also Check: Free Shingles Vaccine Walgreens

    Aetnas Medicare Advantage Plans

    If you decide to get your Medicare Part A and Part B benefits through a Medicare Advantage plan, you might be pleased to know that many of Aetnas Medicare Advantage plans include prescription drug coverage. This type of plan is called a Medicare Advantage Prescription Drug plan.

    Please note that not every plan or plan type is available in all locations.

    Give Shingrix to immunocompetent adults 50 years and older, including those who

    • had shingles in the past
    • received Zostavax® at least 8 weeks prior
    • have health conditions, such as chronic renal failure, diabetes mellitus, rheumatoid arthritis, or chronic pulmonary disease
    • are receiving other vaccines, such as influenza and pneumococcal vaccines, at the same visit
    • are taking low-dose immunosuppressive therapy

    While Shingrix is not contraindicated in immunocompromised people, the Advisory Committee on Immunization Practices at this time does not recommend it for this population. ACIP will review evidence for Shingrix in immunocompromised people as it becomes available.

    Recommended Reading: What Type Of Shingles Are There

    About The Shingles Vaccine

    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.

    Herpes Zoster Vaccine And Hematopoietic Stem Cell Transplant Recipients

    Shingles vaccine is recommended for healthy older adults

    The Centers for Disease Control notes that “A hematopoietic cell transplant results in immunosuppression because of the hematopoietic ablative therapy administered before the transplant, drugs used to prevent or treat graft-versus-host disease, and, in some cases, from the underlying disease process necessitating transplantation. HCT involves ablation of the bone marrow followed by reimplantation of the persons own stem cells or stem cells from a donor. Antibody titers to vaccine-preventable diseases decrease 1 to 4 years after autologous or allogeneic HCT if the recipient is not revaccinated. HCT recipients of all ages are at increased risk for certain vaccine-preventable diseases, including diseases caused by encapsulated bacteria . As a result, HCT recipients who received vaccines prior to their HCT should be revaccinated routinely after HCT, regardless of the source of the transplanted stem cells. Vaccination or revaccination doses of pneumococcal vaccines, DTaP vaccine, Hib vaccine, hepatitis A vaccine, hepatitis B vaccine, meningococcal vaccines, IPV, inactivated influenza vaccines, and human papillomavirus vaccines are recommended after HCT. Varicella, zoster, and MMR vaccines may be administered after HCT if 24 months have passed since HCT, the patient does NOT have graft-vs-host disease, and is considered immunocompetent”.

    Read Also: One Bundle Of Shingles Covers

    Does Aetna Medicare Cover Flu Shots

    • Aetna Medicare Advantage plans cover flu shots, as do all Medicare Advantage plans and Part B of Original Medicare. Learn what other benefits some Aetna Medicare Advantage plans may offer and how you can find a plan that fits your needs.

    Yes, Aetna Medicare Advantage plans cover flu shots.

    With the COVID-19 vaccine being available at no cost to consumers, many older adults may also wonder about the cost and coverage of a flu shot. Beneficiaries enrolled in an Aetna Medicare plan can have their flu shot covered by their Medicare plan in the same way the shot would be covered by Original Medicare .

    What Are The Symptoms

    Shingles symptoms happen in stages. At first you may have a headache or be sensitive to light. You may also feel like you have the flu but not have a fever.

    Later, you may feel itching, tingling, or pain in a certain area. Thats where a band, strip, or small area of rash may occur a few days later. The rash turns into clusters of blisters. The blisters fill with fluid and then crust over. It takes 2 to 4 weeks for the blisters to heal, and they may leave scars. Some people only get a mild rash. And some do not get a rash at all.

    Its possible that you could also feel dizzy or weak. Or you could have pain or a rash on your face, changes in your vision, changes in how well you can think, or a rash that spreads. A rash or blisters on your face, especially near an eye or on the tip of your nose, can be a warning of eye problems.

    if you think you may have shingles. Its best to get early treatment. Medicine can help your symptoms get better sooner. And if you have shingles near your eye or nose, see your doctor right away. Shingles that gets into the eye can cause permanent eye damage.

    Also Check: Does Medicare Part D Cover The Shingles Vaccine

    Why Is The Shingles Vaccine Recommended

    The Centers for Disease Control and Prevention recommends that healthy adults 50 years and older get two doses of Shingrix two to six months apart to prevent shingles and complications from the disease. The vaccine is typically administered to adults who are 50 years and older. There is no maximum age for getting Shingrix.

    It is also given to those who have received a live zoster vaccine in the past.

    The studies report that two doses of Shingrix will be more than 90 percent effective at preventing shingles and its complication called postherpetic neuralgia.

    The vaccine protects you at least 85 percent of the time for the first four years after vaccination.

    You should get Shingrix even if you have a history as follows:

    • Already had shingles

    Recommended Reading: Schedule Shingles Vaccine At Cvs

    Shingles Medicare Billing Problems

    Heres a quick reminder about a billing issue that we commonly resolve for our clients. Many doctors continue to bill this to Medicare Part B, and then the bill gets rejected. Once the rejection happens, far too many Medicare beneficiaries just pay these bills without questioning them. One client remembered that our Client Service Team provides FREE help resolving bills like these and called us for support.

    Her doctors office had tried to bill her $710 for this medication which is ridiculous! The shingles vaccine costs between $150 $300, and if your Part D plan is covering part of the cost, even less. So, please dont pay any medical bills that you receive without checking with us first.

    Do you have questions about which Medicare plans will cover the shingles vaccine? Or perhaps you need help finding a drug plan that includes other vaccines covered by Medicare Part D? Give us a call.

    Recommended Reading: Do I Need A Prescription For The Shingles Vaccine

    Popular Articles
    Related news