Tuesday, April 9, 2024

Does Aetna Silverscript Cover Shingles Vaccine

What Vaccines Does Medicare Part B Cover

Addressing Adult Patientsâ Shingles Vaccine Concerns with Dr. Sandra Leal

Medicare Part B generally covers vaccines for:

One flu shot per flu season. You pay generally nothing if the provider accepts assignment for giving the shot.

People at medium to high risk for Hepatitis B are covered. People at low risk may not be covered. You generally pay nothing if the provider accepts assignment for giving the shot.

  • Pneumococcal to prevent pneumonia

All people with Medicare Part B are covered. You generally pay nothing if your provider accepts assignment for giving the shot.

What Steps Can You Take To Make Sure You Are Covered If You Have Medicare Advantage With Drug Coverage Or Medicare Part D

If you already have Medicare Advantage, or Medicare Part D, contact your provider to check your coverage. Medicare Advantage plans are offered by private companies that Medicare approves.

If you are not yet on Medicare and want to find a plan that covers the shingles shot, you can use Medicares Find a Medicare Plan tool. This tool allows you to compare Medicare Advantage and Part D plans.

Read Also: Is The New Shingles Shot A Live Virus

Its Easy For Members To Switch To Onetouch Products

OneTouch offers multiple blood glucose meters with different features, giving members several choices to fit their needs. OneTouch blood glucose meters are available from:

  • OneTouch without a prescription. Members can visit onetouch.orderpoints.com or call 1-877-764-5390 and use order code 123AET200.
  • Local pharmacies with a prescription. At in-network pharmacies, members pay a $0 copay.

OneTouch test strips are available at pharmacies with a prescription. If the pharmacy is in network, or if members use the Aetna Rx Home Delivery® mail-order pharmacy, theres a $0 copay.

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What Vaccines Are Covered By Medicare Part D

A vaccine covered by Medicare Part D could save your life. According to the Centers for Disease Control and Prevention , vaccine-preventable diseases can cause long-term illness, hospitalization, and even death. Vaccines prepare the body to fight disease faster and more effectively so you donât get sick according to the U.S. Department of Health & Human Services . Vaccines are made from very small amounts of weak or dead germs. The Centers for Disease Control and Prevention recommends the following vaccines for adults 65 and older:

If you are traveling outside of the United States, your doctor might recommend vaccines for other diseases such as yellow fever, typhoid and/or rabies.

Pros And Cons Of Aetna Medicare Part D Plans

What we like about Aetna Medicare Part D Plans: The drawbacks of Aetna Medicare Part D Plans:
  • Lower monthly premiums than many carriers
  • Broad preferred pharmacy network
  • Low cost option for Medicare enrollees who dont need prescription drugs but want a Part D plan to avoid enrollment penalties later
  • Only offered in 22 states
  • Not all plans participate in the Senior Savings Model for insulin
  • Average quality rating from CMS

Recommended Reading: Can You Get Shingles Shot At Walgreens

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.

Is The Shingles Shot Covered By Medicare

Original Medicare does not pay for the shingles vaccine. However, if youre enrolled in a Medicare prescription drug plan or have a Medicare Advantage plan that includes drug coverage, your shot may be covered. For vaccines covered under Part D , it is not recommended to get the shot through your providers office, as you may have issues with Part D billing.*

Also Check: Are There Any Home Remedies For Shingles

What Are Aetna’s Medicare Part D Plan Options

Aetna offers three different Part D Plan options:

  • A basic plan with the lowest monthly premiums and no deductible for drugs in tier 1. It may be best for you if you dont need prescription drugs but need prescription drug coverage to avoid paying late penalties
  • A medium-range plan with a zero deductible for drugs in tiers 1 and 2. A good choice if you qualify for Extra Help.
  • A more comprehensive plan with the highest monthly premium and a zero deductible. This is the only plan that offers the Senior Savings Model for insulin and includes tier 1 and 2 gap coverage and extras such as prescription vitamins and erectile dysfunction drugs.

All three of Aetnas plans include a zero deductible and minimal copay for tier 1 generic drugs from a preferred pharmacy . Initial coverage limits and annual out-of-pocket threshold amounts are the same for all three plans. These types of plans and coverage limits are similar to other carriers of Part D prescription drug coverage. The differences lie in the monthly premiums, formularies, and preferred pharmacies.

Monthly premium costs vary, depending on your state and county. Compare costs for the three 2022 plans in Larimer County, Colorado:

Plan name
$7,050

Does Medicare Cover The Shingles Vaccine

What Does Medicare Actually Cover?

All Medicare prescription drug plans offer some level of coverage for the shingles vaccine. You will find this coverage under your Medicare Part D plan or a Medicare Advantage plan.

The amount you pay will vary based on your policy details and your deductible amount. For some enrollees, the shingles vaccine could be free, but others may pay full price if a deductible must be met before the cost-sharing benefits begin.

The shingles vaccine is not covered by Original Medicare . However, Medicare Part B may cover a doctor’s visit to get a prescription for the shingles vaccine.

Most Medigap plans, also called Medicare supplement plans, don’t cover the shingles vaccine because they don’t include prescription drug coverage.

Medicare plan
Wellcare $28-$47

Typical costs based on available plans in Charlotte, N.C. , Boston , and Los Angeles .

Find Cheap Medicare Plans in Your Area

Remember that coverage for the shingles vaccine is usually just one aspect of your prescription drug needs. And the best Medicare Part D plan for you is determined by its total performance, including how well its coverage matches your prescription needs.

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Why Is Aetna Changing To Wellcare

Aetna has agreed to sell its Medicare Part D drug plan business to WellCare Group. The deal was made in the hopes of winning regulatory approval from the Trump administration for its $69 billion merger with CVS Health. For WellCare Group, the transaction would mark the third deal in just over two years.

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.

Recommended Reading: When Does Shingles Pain Stop

How Much Does Silverscript Cost Per Month

Each SilverScript Medicare Part D plan has a different monthly premium. Additionally, SilverScript monthly premiums vary by ZIP Code.

However, the SilverScript SmartRx is the lowest-cost Medicare Part D plan in many areas. The plan starts as low as $7 per month.

Find Medicare Plans in 3 Easy Steps

We can help find the right Medicare plans for you today

The SilverScript Medicare Part D plan with the higher monthly premium is the SilverScript Plus . The monthly premium for this plan starts at $70.

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.

RELATED: Find a pharmacy near you

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Get A Jump Start On The Silversneakerssm Fitness Benefit

Did you know your Aetna and Coventry MA/MAPD clients get a no-cost membership at participating SilverSneakers fitness facilities? Yep! Its included with their 2018 MA/MAPD plan. Heres the basic information your MA/MAPD clients need to know:
  • Once enrolled, members just need their SilverSneakers ID number.
  • If this is their first time with a plan that has SilverSneakers, theyll get their SilverSneakers ID number in the mail.
  • If members previously had a plan with SilverSneakers , their SilverSneakers ID number remains the same. Members can look up their number by calling SilverSneakers or visiting com.
  • Next, they can find participating fitness locations at com.
  • Then let the fun and fitness begin.
  • Want to let your clients know about this benefit? Download a SilverSneakers fitness flyer from the Aetna Medicare Marketing Studio today to share with your clients.

    What Are The Costs For Medicare Part D Vaccines

    The fact that a vaccine is covered by Medicare Part D does not necessarily mean you pay nothing for this vaccine. What you pay for a Medicare Part D vaccine depends on:

    • The type of vaccine
    • Where you get the vaccine
    • Who gives you the vaccine

    In some cases, you may have to pay the entire cost for the vaccine medication and the administration of the vaccine and ask your Medicare Part D plan to pay you back for a share of the cost.

    Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealthâs Medicare related content is compliant with CMS regulations, you can rest assured youâre getting accurate information so you can make the right decisions for your coverage.Read more to learn about our Compliance Program.

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    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.

    Does Medicare Cover Shingles Vaccines

    Save Money on the Shingles Vaccine (Original Medicare DOESN’T Cover It!)

    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.

    Read Also: What Can I Put On Shingles Rash

    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.

    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: How To Know You Have Shingles

    Does Medicare Cover Shingles Vaccines In 2022

    Shingles is a viral infection caused by the varicella-zoster virus . It produces a painful rash with fluid-filled blisters and typically shows up on one side of the body. The same virus that causes chickenpox causes shingles. Anyone who has had chickenpox in the past is at risk of getting shingles.

    Shingles is a painful rash that occurs along the distribution of a nerve, called a dermatome, says Erum N. Ilyas, MD, a fellow of the American Academy of Dermatology and founder of AmberNoon. The virus lays dormant in the nervous system. Immunity likely plays a role in preventing the virus from reactivating. When immunity is low, the virus replicates and spreads down the nerve causing pain, inflammation, and blistering.

    The Centers for Disease Control and Prevention recommends that adults older than 50 get the shingles vaccine. Shingles can cause long-term nerve pain and nerve damage. Getting two shingles vaccine doses two to six months apart has proven to be very effective at preventing shingles.

    Shingrix is a brand-name shingles vaccine and is currently the only shingles vaccine available in the United States. Zostavax, a previous zoster vaccine, wasdiscontinued in 2020.

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    Where Can I Get Vaccines I Need

    You can get most vaccines at a pharmacy, doctors office, clinic or community health center. Talk with your doctor about what vaccines you may need. Your doctor or Part D plan provider can also help you understand whether your cost will be affected by where you go to get the vaccines that your doctor recommends.

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    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.

    Recommended Reading: What To Do When You Get Shingles

    What Happens When You Get The Vaccine

    As mentioned above, there is one option for the shingles vaccine: Shingrix.

    Shingrix, which contains no live virus, is a two-dose vaccine series given in the muscle of the upper arm. The second shot is given two to six months after the first. In clinical trials, it was effective in nearly 97% of adults in their 50s over 97% effective for people in their 60s and over 91% effective for those aged 70 and above. It remains at near 85% effectiveness in all four years following vaccination.18

    Shingrix is recommended if youre age 50 or older and have no severe immune problems.19

    Effectiveness does come with a cost: In studies, seven in 10 people experienced pain from the Shingrix vaccine, and nearly half have muscle pain or fatigue and some had headaches, shivering, fever and nausea.20 21The CDC suggests avoiding strenuous activities for two to three days after getting either Shingrix shot.

    If have previously received Zostavax, you can consider getting Shingrix. The CDC says Shingrix was safe and immunogenic when given five years or later after Zostavax. The agency adds there is no data or theoretical concerns that Shingrix would be any less effective if given sooner. 21

    Zostavax was discontinued in 2020 by Merck and is no longer available in the United States.

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