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.
What Medicare Advantage Plans Does Aetna Have
You may have heard that Medicare Advantage plans are an alternative way to get your Medicare benefits from a private insurance company. As the name suggests, Medicare Advantage plans may have some âadvantagesâ that Original Medicare doesnât have, including additional benefits and coverage. You also never have to worry that your Medicare Advantage coverage will be inferior to Original Medicare. Medicare Advantage plans are required to cover at least everything that Original Medicare covers, with the exception of hospice care, which is still covered by Medicare Part A.
Do I Need A Prescription For A Shingles Vaccine
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.
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Meningococcal Vaccine Also Available
A meningococcal vaccine is not recommended for all adults. This vaccine may be recommended for you if you have certain risk factors due to your age, health, job, or lifestyle. Talk to your doctor or pharmacist to see if you need this vaccine.
This vaccine is available through local pharmacies as well as in a doctors office.
Where And How To Get Vaccinated For Shingles
Medicare requires all Part D plans to cover the shingles vaccine. However, since Part D plans have networks, youll want to be sure you get the vaccine at a pharmacy in the plans network.
Do not get the shingles vaccine at your doctors office. Doctors offices dont have the ability to bill Part D plans. Therefore, getting the vaccine at your doctors office could result in you paying the entire bill and having to submit a reimbursement request to your plan.
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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
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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Find Medicare Advantage Coverage For The Shingles Vaccine
Contact a licensed insurance agent today to find out if a Medicare Advantage plan is available where you live that will cover the shingles vaccine.
Find Medicare plans that cover the shingles vaccine
Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!
1 Umansky, Diane. The New Shingles Vaccine: What You Should Know About Shingrix. . Consumer Reports. Retrieved from www.consumerreports.org/shingles-vaccine/new-shingles-vaccine-shingrix-what-you-should-know.
2 Centers for Disease Control and Prevention. Shingles Vaccination. . Retrieved from www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html.
About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles hes written, helping Americans better understand their health insurance and Medicare coverage.
Christians work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christians passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
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Does Aetna Medicare Cover Other Vaccines
A flu shot isnt the only vaccine that can be covered by Aetna Medicare Advantage plans. Aetna Medicare Advantage plans may also cover the pneumonia and Hepatitis B vaccinations, while some Aetna Medicare Part D prescription drug plans may cover the Tdap and shingles shots , among others.
Like the flu shot, the pneumococcal and Hepatitis B vaccines are fully covered by Aetna Medicare Advantage plans when administered by a participating Aetna health care provider. Shots covered by an Aetna Medicare Part D may require a deductible and/or cost-sharing.
Meningococcal, polio and HPV shots may also be covered by an some Aetna Medicare Advantage plans or Aetna Medicare Part D plans.
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Safety And Effectiveness Of Acellular Pertussis Vaccination During Pregnancy
Nasser and associates stated that pregnant travelers and their offspring are vulnerable to severe outcomes following a wide range of infections. Vaccine-preventable diseases can have a particularly severe course in pregnant women, but little is known about the safety of travel vaccines in pregnant women. These researchers performed a systematic review of all published literature concerning the safety of vaccines frequently given to travelers such as yellow fever, MMR , influenza, Tdap , meningococcus, hepatitis A and B, rabies, polio, typhoid fever, tick-borne encephalitis and Japanese encephalitis vaccines. They included case-series studies, cohort studies and randomized controlled trials . For the meta-analysis, these investigators included only RCTs that compared the administration of a vaccine to placebo or to no vaccine. Outcome measures included severe systemic adverse events , maternal outcomes related to the course of pregnancy, neonatal outcomes and local AEs. They calculated the RR and its 95 % CI as the summary measure. The safety of influenza vaccine was supported by high-quality evidence. For Tdap vaccine, no evidence of any harm was found in the meta-analysis of RCTs. A slight increase in chorioamnionitis rate was reported in 3 out of 12 observational studies. However, this small possible risk was far out-weighed by a much larger benefit in terms of infant morbidity and mortality.
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.
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Cpt Codes Covered If Selection Criteria Are Met:
90471 Immunization administration one vaccine + 90472 each additional vaccine 90700 Diphtheria, tetanus toxoids, and acellular pertussis vaccine , when administered to individuals younger than 7 years, for intramuscular use 90715 Tetanus, diphtheria toxoids and acellular pertussis vaccine , when administered to individuals 7 years or older, for intramuscular use
S For Getting Coverage For The Shingles Vaccine
If you currently only have Original Medicare, how can you get coverage for the shingles vaccine? First, you will need to sign up for a Medicare Advantage Plan or a Medicare Part D prescription drug plan to get coverage for the shingles vaccine. You should thoroughly research the plans available in your area. Eligibility for Advantage plans is based partly on where you live, so not all plans are available in all areas. An independent insurance agent can also help you choose the best Medicare Advantage plan for your needs.
Once you find a plan that meets your needs, you should check the coverage details to make sure that the shingles vaccine is covered. More than likely, you will need to meet a deductible before the plan pays for treatment. If you have already met your deductible and paid for the vaccine out-of-pocket, then you might be eligible for reimbursement for some of the charges. If you have questions about Medicare coverage for the shingles vaccine, there are many resources available at Medicare.gov. You can also give them a call at 1-800-633-4227 or TTY at 1-877-486-2048.
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Why Doesnt Medicare Cover The Shingles Vaccine As Free For All Seniors
Many people think that a vaccine thats recommended by the CDC for those over age 50 would be fully covered by Original Medicare. However, there are a few reasons why you may end up paying hundreds of dollars for the two-dose regimen.
- Medicare coverage levels: Some Medicare drug plans have better cost-sharing benefits than others, and how much you pay for the shingles vaccine depends on the plan you choose.
- Pharmaceutical classification: Medicare classifies the Shingrix vaccine as a part of its pharmaceutical coverage, meaning it would fall under Medicare Part D coverage rather than Part A or Part B. In contrast, most private health insurance, either through an employer or through the marketplace, classifies the shingles vaccine as a part of its free preventative coverage.
- Type of pharmaceutical: Shingrix is a Tier 3 drug made by GlaxoSmithKline, and there isnt a generic alternative. This could mean that your out-of-pocket costs are higher than for other medications.
Recommended Reading: When To Get 2nd Shingles Vaccine
Vaccines Covered By Medicare Part D
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.
Where Can I Get More Information About Medicare Coverage For The Tetanus Shot
If you have questions about Medicare coverage for prescription drugs, including the TDAP vaccine, I am happy to assist you click the View profile link to learn more about me. To schedule a phone call or request a personalized email, click one of the buttons below. Learn more about Medicare plan options available in your area by clicking the Compare Plans button.
For more information on the tetanus vaccine, see:
Centers for Disease Control and Prevention, Tetanus: Make Sure Your Family is Protected, last updated June 29, 2015.
This website and its contents are for informational purposes only. Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.
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Recommended Reading: Can You Have Shingles More Than Once
Shingrix Coupons And Rebates
Shingrix offers may be in the form of a printable coupon, rebate, savings card, trial offer, or free samples.Some offers may be printed right from a website, others require registration, completing a questionnaire,or obtaining a sample from the doctors office.
There are currently no Manufacturer Promotions that we know about for this drug.
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Medicare Coverage Of The Tetanus Shot
The TDAP vaccine, unlike the flu and pneumonia shots, are covered under Medicare prescription drug coverage, also known as Medicare Part D. If you are only enrolled in Original Medicare , you dont get Part D coverage automatically. Instead, you can get coverage for your tetanus shot under Part D through a stand-alone Medicare Prescription Drug Plan.
Coverage for the TDAP shot is also available through a Medicare Advantage plan that includes prescription drug coverage. These plans must provide all the benefits available under Original Medicare, but in many cases, they include additional benefits not covered under Part A and Part B. Medicare Advantage plans often include benefits for routine vision or dental, hearing, and wellness programs, for example. They also often include prescription drug coverage, also known as Medicare Advantage Prescription Drug plans.
If you get your prescription drug benefits through a Medicare Advantage plan, you cannot enroll in stand-alone Medicare coverage for prescription drugs through a Medicare Prescription Drug Plan.
Medicare Part D generally covers all commercially available vaccines that are medically necessary to prevent illness. The vaccine must typically be prescribed and administered by a health-care provider who participates in Medicare, and your costs are usually lowest if the provider accepts Medicare assignment. There may be cost sharing involved with Medicare coverage of the TDAP shot, which will vary by plan.
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