Does Blue Cross Blue Shield Cover The Shingles Vaccine

Bcbstx Approves Coverage Of New Shingles Vaccine Shingrix

Blue Cross and Blue Shield of Texas now covers Shingrix, a new two-dose vaccine for reducing shingles and related nerve pain that was approved by the Food and Drug Administration in October 2017. Until recently, the only vaccine available for shingles was Zostavax®, which is 51 percent effective. Clinical trials show Shingrix is 91 percent effective.

For immunocompetent adults ages 50 and older, the Advisory Committee on Immunization Practices recommends Shingrix over Zostavax. They also recommend that immunocompetent adults who have already had Zostavax also get Shingrix.

BCBSTX covers two doses of Shingrix administered to patients ages 50 and older, even if they have already received Zostavax based on current ACIP recommendations. It is important to check eligibility and benefits information to confirm details regarding copays, coinsurance and deductibles before administering this vaccine to BCBSTX members.

*Zostavax and Shingrix prescribing information

For more information on Shingrix, see the Center for Disease Control and Preventions . Or see the FDA-approved prescribing information for Shingrix.

Third-party brand names are the property of their respective owner.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

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 licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.

Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.

Where youve seen coverage of Christians research and reports:

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE , 24 hours a day/7 days a week or consult www.medicare.gov.

Shingles: Chickenpox Part Ii

For many adults, getting chickenpox was an unavoidable part of childhood. But if youve had chickenpox, you also have a 1 in 3 chance of developing shingles. Thats because the virus that causes chickenpox never leaves your body completely. Rather, it lies dormant and can reemerge later as shingles.

Thankfully, there are things you can do to protect yourself from getting shingles. Heres what you need to know:

What is shingles? Shingles is a painful skin rash with blisters that can lead to long-term nerve pain. It can also cause fever, headache, chills, and upset stomach. The blisters typically scab over in 7 to 10 days and fully clear up within 2 to 4 weeks.

Is shingles serious? In some cases, shingles may have serious complications. The most common is long-term nerve pain. If the rash occurs on the face, shingles could affect the eye and cause vision loss.

What causes shingles? Shingles is caused by the same virus that causes chickenpox. After you have had chickenpox, the virus remains inactive in your body and if/when re-activated will cause shingles.

The exact reason why the virus reactivates and causes shingles is unclear. But it may be due to lowered immunity to infections as you grow older.

Can I get shingles more than once? While most people have only one episode of shingles in their lifetime, it is possible to have multiple episodes. The exact reason for this is unknown.

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What Is The Cost Of The Shingles Vaccine With Medicare Part D

Since every insurance plan is different, each Part D plan provides varying degrees of coverage for the shingles vaccine. Some plans may place the vaccine in Tier 1 while others may put it under Tier 3 . Some plans may also have a deductible, meaning 100% of your vaccination or drug costs are on you until you meet the dollar amount specified by your insurance plan.

The best way to know how much a shingles vaccine may cost you is to call your insurance provider and ask.

Enroll In A Medicare Advantage Plan

Another option is to enroll in a Medicare Advantage plan, sometimes referred to as Medicare Part C. Theyre very popular. The Kaiser Family Foundation reported that 36 percent of Medicare beneficiaries approximately 24.1 million people are enrolled in Medicare Advantage plans.

Medicare Advantage plans are offered by private insurance companies and bundle your Part A and Part B benefits together. Most plans also offer prescription drug coverage and other services as well. Medicare Part C plans often cover items and services that Original Medicare doesnt, such as dental care, hearing aids, and glasses.

Your Medicare Advantage plan will cover the Shingrix vaccine only if you select a plan that offers prescription drug coverage.

In terms of cost, Medicare Advantage plans can be quite affordable. The average monthly premium is just $25, but many plans have $0 premiums. That cost is on top of your Medicare Part B premium. According to the Centers for Medicare & Medicaid Services, the standard monthly premium for Medicare Part B enrollees is $144.60 for 2020.

You can use the Medicare Plan Finder to view available plans, compare coverage options, and see plan pricing so you can enroll in the right Medicare plan for you.

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Seasonal Flu Coverage And Benefits

One of the most important steps you can take to protect your health and well-being is to get an annual flu shot. Each year thousands of people are hospitalized because of complications from the flu. Thats why we encourage all our members to get their yearly flu vaccination.

Most Independence Blue Cross members with prescription drug coverage will pay $0 for a flu shot at an in-network pharmacy or provider.¹ Members will not need a referral, precertification, or preapproval to get their seasonal flu vaccine.

Whether in or outside of our service area, members should be able to receive a flu shot from in-network providers without having to pay upfront or submit a form for reimbursement.

Find an in-network provider

To find an in-network pharmacy or provider near you, log in at ibx.com.

Please note: For members who have 100 percent coverage for services in accordance with the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010, no cost-share should be applied for the vaccine and administration of the vaccine when it is administered by an in-network provider.

Coverage is subject to the terms and conditions of the applicable benefit plan. Individual benefits must be verified.

Can The Covid Vaccine Cause Shingles

According to a small study by the University of California External Site, there is currently no evidence that proves the COVID vaccine can cause shingles External Site. However, scientists say that after you get the COVID-19 shot, your immune system gets busy creating antibodies. This means your immune system may become temporarily compromised to other health conditions .

Researchers are still getting a better understanding of how the COVID-19 vaccine impacts a potential shingles outbreak. One clinical trial External Site has even suggested that getting the shingles vaccine may help your body fight off the flu and COVID-19.

Also Check: Do I Need To See A Doctor For Shingles

Government Funding Of A Vaccine Is Complicated

Its no surprise to microbiologist Dr. Allison McGeer that the Shingrix vaccine not being covered because its a process that involves many variables.

Theres a whole lot of complicated logistical planning that goes into how a government would decide to fund and deliver a vaccine it feels like something really simple but its actually not, Dr. McGeer says.

Also Check: Is The New Shingles Vaccine A Live Virus

Where Can You Get Your Shots And Vaccines

If you have health insurance, choosing an in-network provider or a retail clinic that participates in your insurance plan can help you keep costs lower. You can get shots from an out-of-network provider, but you may be asked to pay the full price.

If you have a CareFirst health insurance plan, learn more about what vaccines are covered in the Summary of Preventive Services or ask Member Services any questions you may have.

If you are a member of another health plan, or are comparing available benefits, ask your health insurers Member Services office what vaccines are covered with your health insurance.

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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.

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What Can Be Done About Shingles

Once a person has gotten the chickenpox virus, there is no effective way to eliminate it from the body. This leaves open the possibility of a shingles outbreak for life. Several commercially available vaccines can treat the condition by reducing the risk of flare-ups or by reducing the intensity and duration of episodes of shingles.

One of the most popular vaccines is known by the trade name SHINGRIX. The SHINGRIX vaccine is considered to be 90% effective at preventing shingles outbreaks among seniors aged 50 and over. SHINGRIX comes in two doses, one administered 2 to 6 months after the first.

Several generic shingles shots are also available on the market.

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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.

Why Doesn’t Medicare Cover The Shingles Vaccine As Free For All Seniors

Many people think that a vaccine that’s 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 isn’t a generic alternative. This could mean that your out-of-pocket costs are higher than for other medications.

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Bluecross Blueshield Breaks Down The Facts About Vaccines

Buffalo, NY- Scientists years ago proved that vaccines are safe and effective, according to the Centers for Disease Control and Prevention, yet common misconceptions about vaccines can confuse parents.

As flu season approaches, Dr. Thomas Schenk breaks down the facts about vaccines in BlueCross BlueShield of Western New Yorks latest free Point of Health audiocast. Dr. Schenk, a pediatrician, is senior vice president and chief medical officer of the health plan.

The flu vaccine helps maintain overall health and decreases the number of deaths, hospital admissions and length of stay. Its recommended that individuals age six months and older receive the flu vaccine each year. It is generally available at local pharmacies and medical offices.

The new audiocast is the latest in the health plans Point of Health series launched in December of 2016. Hosted by BlueCross BlueShields Vice President, Corporate Relations, , Point of Health audiocasts are posted bi-monthly and feature an interview with experts on health insurance and health care, covering a variety of perspectives and information.

To listen to this episode, as well as past and future episodes visit www.bcbswny.com/pointofhealth.

For up-to-date news, facts, and information about the company, leadership, and industry, please visit the BlueCross BlueShield News Center or follow us on .

The Vaccines Have Been Shown To Reduce The Risk Of Getting Shingles By 50% For Zostavax Ii And To More Than 90% For Shingrix

Most individuals with private insurance pay little to nothing for both doses of shingles vaccines, whereas those covered by other types of insurance may need to copay some amount. Payment policy | immunizations adult and pediatric. For blue cross blue shield plans offered by carefirst, vaccinations are completely free.

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You Can Get A Shingles Vaccine Two Ways:

At the pharmacy. Youll still need a doctors prescription, but once thats been transmitted, you can get the shot at a retail pharmacy.

Most major chains and some independent pharmacies can administer the vaccine. Just make sure to use a store in your drug plans network so that it can bill your plan directly and youll owe just the copayment.

At the doctors office. If youre vaccinated in a doctors office, check whether it can bill your drug plan directly or works with a pharmacy that can do so. If so, it will work as mentioned above, with you owing a copayment. If not, you may need to pay the full cost up front and then file a claim for reimbursement from your plan.

Remember that the doctors fee for administering the vaccine may exceed your plans allowable charge, in which you case youre on the hook for the difference. It pays to check beforehand.

Editors note: This article was originally published on Jan. 1, 2014. It has been updated with the latest information regarding Medicare coverage in 2020.

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Does Blue Cross Blue Shield Cover Vaccines

• Blue Cross Blue Shield Medicare Advantage plans cover the same vaccines that Original Medicare covers, and some BCBS Medicare plans my cover additional vaccines that Original Medicare doesnt. Learn more about BCBS Medicare and the preventive health care these plans may cover.

Vaccines are an integral part of keeping infectious diseases at bay, and many Anthem Blue Cross Blue Shield plan members might wonder if their plan will cover their shots. Anthem BCBS is part of the Anthem family of brands.

Blue Cross Blue Shield health insurance and Blue Cross Blue Shield Medicare Advantage plans do indeed cover a wide range of vaccines. Below is a breakdown of what vaccines are covered by which BCBS plans.

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What You Need To Know About Shingrix The Latest And Preferred Shingles Vaccine

In January 2018, the Centers for Disease Control and Prevention updated its recommendation on vaccinating against the shingles virus, preferring a new vaccine called Shingrix®. Since 2006, Zostavax® was the only shingles vaccine on the market. So, the move to now use Shingrix® is important to understand. The CDC recommends that people get the new vaccine, even if theyve already gotten the Zostavax® shot since its more effective. Data shows that the Shingrix® vaccine is 97 percent effective for those 50 and up, whereas Zostavax® is only 51 percent effective.

The Shingrix® vaccine is approved for people 50 and older to protect against the development of shingles, a rash that develops on either the right or left side of the body and appears in painful, itchy, inflamed blotches.

Also known as herpes zoster, shingles will affect about one-third of Americans in their lifetime. The condition typically lasts two to four weeks.

Shingles cannot be passed from person to person, but the virus that causes the condition, varicella zoster virus can spread from an infected person and cause chickenpox in someone who never had chickenpox or received the chickenpox vaccine.

As you evaluate whether the Shingrix® vaccine is right for you, here are a few other considerations to keep in mind: