Tuesday, February 20, 2024

Does Cigna Cover Shingles Vaccine

Shingles Vaccine Coverage Helps Customers Prepare For Prevention

Yes, you can get the shingles vaccine after getting your COVID vaccine

The itchy memories of a bout with chicken pox will fade, but the virus that causes it lingers on. Later in life, that same virus can manifest again as shingles a painful rash with blisters that can lead to long-term nerve pain. Anyone age 50 or older who suffered from chicken pox previously is at higher risk.1 In fact, 1 in 3 people in the U.S. will get shingles during their lifetime.1 Fortunately, theres a highly effective vaccine available and its covered by Cigna pharmacy plans.

The shingles vaccine is easily accessible.The shingles vaccine is approved by the U.S. Food and Drug Administration and more than 90% effective.1 Individuals can get the shingles vaccine at their local, in-network retail pharmacy.To find a pharmacy, customers can log in to the myCigna® App or myCigna.com and choose the Find Care & Costs tab. Then click on Health Facilities and select Pharmacy from the dropdown menu to start searching. Theres no need for an appointment. Customers can simplystop in and ask to get the vaccine any time.

The shingles vaccine is:

  • Meant for everyone at risk even those whove already had shingles Its possible to get shingles more than once.1
  • Given in two doses Two doses are necessary for full protection. The second dose is given two to six months after the first.1
  • Okay to take with a flu shot The U.S. Centers for Disease Control and Prevention affirm its okay to get the shingles and flu vaccines at the same time.2

Talk With Your Health Care Provider

Tell your vaccine provider if the person getting the vaccine:

  • Has had an allergic reaction after a previous dose of live shingles vaccine or varicella vaccine, or has any severe, life-threatening allergies.
  • Has a weakened immune system.
  • Is pregnant or thinks she might be pregnant.
  • Is currently experiencing an episode of shingles.

In some cases, your health care provider may decide to postpone shingles vaccination to a future visit.

People with minor illnesses, such as a cold, may be vaccinated. People who are moderately or severely ill should usually wait until they recover before getting live shingles vaccine.

Your health care provider can give you more information.

Does Medicare Cover Shingrix Or Zostavax

Many Medicare Part D and Medicare Advantage plans provide coverage for Shingrix and/or Zostavax.

  • Medicare Part D plans provide coverage exclusively for prescription drugs.
  • Medicare Advantage plans provide coverage for all Medicare Part A and Part B benefits, and most Medicare Advantage plans also cover prescription drugs. Some plans also offer dental, vision and hearing benefits, along with a range of other benefits that Original Medicare doesnt cover.

Both Medicare Advantage plans and Part D plans are sold by private insurance companies.

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How Much Does The Shingles Vaccine Cost

The amount you pay for the shingles vaccine will depend on how much your Medicare plan covers. Remember that if you only have original Medicare and no prescription drug coverage through Medicare, you may pay full price for the vaccine.

Medicare drug plans group their medications by tier. Where a drug falls on the tier can determine how expensive it is. Most Medicare drug plans cover at least 50 percent of a drugs retail price.

PRice ranges for the shingles vaccine

Shingrix :

  • Deductible copay: free to $164 for each shot
  • After deductible is met: free to $164 for each shot
  • Donut hole/coverage gap range: free to $74 for each shot
  • After the donut hole: $7 to $8

To find out exactly how much you will pay, review your plans formulary or contact your plan directly.

Risks Of A Vaccine Reaction

Advance Walkin Clinic &  Urgent Care
  • Redness, soreness, swelling, or itching at the site of the injection and headache can happen after live shingles vaccine.

Rarely, live shingles vaccine can cause rash or shingles.

People sometimes faint after medical procedures, including vaccination. Tell your provider if you feel dizzy or have vision changes or ringing in the ears.

As with any medicine, there is a very remote chance of a vaccine causing a severe allergic reaction, other serious injury, or death.

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How Is Shingles Treated

Shingles is treated with medicines. These medicines include antiviral medicines and medicines for pain. Treatment may shorten the illness and prevent complications.

See your doctor right away if you think you may have shingles. Starting antiviral medicine right away can help your rash heal faster and be less painful. And you may need prescription pain medicine if your case of shingles is very painful. It’s important to see your doctor right away if you have shingles near your eye or nose. Treatment can help prevent permanent eye damage.

Other treatments may help with intense pain. Getting pain under control right away may prevent nerve damage that may cause pain that lasts for months or years.

Good home care also can help you feel better faster. Avoid scratching blisters. Apply baking soda to help dry the sores. Soak crusted sores with tap water to clean away crusts and soothe the skin.

Health Tools help you make wise health decisions or take action to improve your health.

  • Shingles: Should I Get a Vaccine to Prevent Shingles?

Shingles occurs when the virus that causes chickenpox starts up again in your body.

After you’ve had chickenpox, the virus “sleeps” in your nerve roots. In some people, it stays dormant forever. In others, the virus “wakes up.” In this case, you may get a rash that occurs only in the area of the affected nerve.

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 Treat Shingles Virus

Do I Have To Make An Appointment

The COVID-19 vaccine requires making an appointment ahead of time at CVS.com. Most other vaccines are available on a walk-in basis. Same-day appointments are often available online. You can also answer the vaccine-specific questionnaire online instead of filling it out in person.

You may want to call ahead to your local CVS Pharmacy and make sure your desired vaccine is in stock. You can also check to see if theres a wait at the store or clinic.

How Much Does The Shingles Vaccine Cost With Medicare

Shingles Vaccine Update

Most people who are enrolled in Medicare Part D pay less than $50 per dose for Shingrix, according to the vaccines manufacturer GlaxoSmithKline. However, your costs will vary based on the plans details and if youve already met your deductible amount by purchasing other prescription drugs.

For example, some seniors can get the shingles vaccine for free because its fully covered by their Medicare Part D or Medicare Advantage plan. Others may have to pay a portion of the cost, such as a $50 copay per shot, or pay full price if the deductible hasnt been met.

If you dont have a prescription drug plan or you havent met your plans deductible, the retail cost for the shingles vaccine is $162 per shot in 2021. For the two-dose sequence, the total cost is $324. If the full price of the shingles vaccine is out of your budget, there are several ways you can save money on the vaccine.

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What Are Your Chances Of Getting Shingles

Only people who have had chickenpox can get shingles.

Out of 100 people, about 30 may get shingles sometime in their lives. footnote 2 And the risk is higher for people age 50 and older. Older people are also more likely to have severe pain with shingles.

Most people who get shingles will not get it again. But some people get shingles more than once.

What Are The Side Effects Of Shingrix

The most common side effects include pain and inflammation at the injection site, headache, muscle pain, fatigue, stomach discomfort, fever, and shivering, according to GSK.

Allergic reactions are less common but still possible. Watch for signs of an allergic reaction, such as hives, swelling of the face or throat, trouble breathing, rapid heartbeat, dizziness, and weakness. This is considered an emergency, so call 911.

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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 will depend on your Medicare Part D plan or with your Medicare Advantage prescription drug benefits. Seniors who dont 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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What Kind Of Insurance Does Cvs Accept For Vaccines

CVS accepts more than 5,000 health insurance plans for vaccinations. Many routine vaccinations are considered preventive care under the Affordable Care Act and must be covered with no charge to you for visits to an in-network provider.

As a result, people with private insurance often find they have zero copays for routine vaccinations at retail pharmacies. But youll want to check with your plan or ask the pharmacist to run your insurance card before you receive the vaccine to be sure.

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Cdc Shingles Vaccine Recommendations

The Centers for Disease Control and Prevention recommends Shingrix vaccination for everyone 50 years and older and those 19 years and older who have weakened immune systemseven if you have already had shingles, if you had another type of shingles vaccine, and if you dont know whether or not youve had chickenpox in the past.

You should not get the vaccine if you have a severe allergy to any of the components, currently have shingles, or you have lab tests that definitively show that you do not have antibodies against the varicella-zoster virus. In that case, you may be better off getting the varicella vaccine instead. Also, those who are pregnant should consider delaying vaccination with Shingrix until after delivery.

California Employer Drug Lists

Cigna Standard Prescription Drug List

California Standard 3 Tier*

California Standard 3 Tier*

California Standard 4 Tier*

California Standard 4 Tier*

California Standard 4 Tier*

California Standard 4 Tier*

Cigna Value Prescription Drug List

California Value 3 Tier*

California Value 3 Tier*

California Value 4 Tier*

California Value 4 Tier*

California Value 4 Tier*

California Value 4 Tier*

Cigna Performance Prescription Drug List

California Performance 3 Tier**

California Performance 4 Tier **

Cigna Advantage Prescription Drug List

California Advantage 3 Tier**

California Advantage 4 Tier **

Cigna Legacy Prescription Drug List

California Legacy 3 Tier*

California Legacy 3 Tier*

California Legacy 4 Tier*

California Legacy 4 Tier*

California Legacy 4 Tier*

California Legacy 4 Tier*

Cigna Legacy Prescription Drug List

California Legacy 3 Tier**

California Legacy 4 Tier **

Cigna Total Savings Prescription Drug List

California Total Savings 3 Tier*

Cigna National Preferred Prescription Drug List

California National Preferred 3 Tier*

California National Preferred 3 Tier*

* Drug list for the State of California for these products: Health Maintenance Organization, Point of Service, Network, Preferred Provider Organization, Exclusive Provider Organization, Open Access Plus, Open Access Plus In Network, LocalPlus, LocalPlus IN, Surefit.

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Find Cheap Medicare Plans In Your Area

The shingles vaccine is covered under your prescription drug benefits through Medicare Part D or Medicare Advantage. However, your actual cost and coverage will depend on the specifics of your plan. If you dont have a prescription drug plan, the full price for two doses of the Shingrix vaccine is $324, and several cost-saving options can help you get Shingrix for less.

What Happens If You Get The Shingles Vaccine And You Never Had Chickenpox

Shingles: What you need to know about causes, symptoms, and prevention.

If youve never had chicken pox, no. If you did not get chicken pox as a child, dont get either vaccinations, it is likely that you are immune to the disease. Its very rare to give an adult the vaccine for chicken pox. Adults do not do well with childhood vaccinations because they can end up with complications.

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How Well Does The Vaccine Work

The vaccine lowers your chances of getting shingles.

If you get the vaccine and still get shingles, you are likely to have much less pain and for a much shorter time.

The Centers for Disease Control and Prevention recommends two doses of the shingles vaccine for adults ages 50 and older and for adults 19 and older who have a weakened immune system. footnote 1

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.

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Other Types Of Plans Do Better

Other forms of insurance do a far better job covering immunizations.

Under provisions of the Affordable Care Act, private planssuch as insurance through your employer or purchased on a state marketplaceare still required to cover recommended vaccinations as preventive medical care, not drugs.

That means that as long as you go to a provider in your plans network, your insurance will pay for preventive care without a co-pay, even if you havent met your deductible.

Its really a shame that older Americans, who are most at risk of contracting shingles and most vulnerable to the potentially serious effects of the disease, often have to pay more than others for the vaccine, says Consumer Reports medical director, Orly Avitzur, M.D.

If youre currently covered by a private health plan but anticipate going on Medicare in the next five years or so, one cost-saving strategy is to talk to your doctor about updating all your vaccinations now while your insurance provides good coverage, Avitzur says. The shingles shot is recommended for nearly all adults aged 60 and older.

What If There Is A Serious Problem

An allergic reaction could occur after the vaccinated person leaves the clinic. If you see signs of a severe allergic reaction , call 9-1-1 and get the person to the nearest hospital.

For other signs that concern you, call your health care provider.

Adverse reactions should be reported to the Vaccine Adverse Event Reporting System . Your health care provider will usually file this report, or you can do it yourself. Visit the VAERS website at www.vaers.hhs.gov or call 1-800-822-7967.VAERS is only for reporting reactions, and VAERS staff do not give medical advice.

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What Are The Risks And Side Effects Of The Shingles Vaccine

Side effects include:

  • Redness, swelling, or soreness at the spot where the needle went in.
  • A high fever or serious allergic reaction .

Getting the vaccine has some risks. For example:

  • You might get shingles anyway. But it probably won’t be as painful or last as long.
  • You may need another vaccine later in life.

You shouldn’t get the vaccine if:

  • You are ill with more than a mild cold or you have had an allergic reaction to the first dose.
  • You have a test that says you have never had chickenpox.
  • You have shingles.
  • You are pregnant or breastfeeding.

Does Medicare Cover The Shingles Vaccine Will I Have To Pay For The Shot

The CDC recommends people 50 years and older get the shingles vaccine. The shot is widely available and the cost may be covered if you have Medicare Advantage or Medicare Part D. Depending on your plan, you may have to cover a deductible, co-pay, or pay for the shot out of pocket and get reimbursement.

Shingles can cause serious complications, like painful long-term nerve damage. To stay safe from such complications, you may want to consider the new shingles vaccine . An older vaccine once widely administered in the U.S. was less effective and is no longer on the market.

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When Do Cigna Medicare Plans Pay For Flu Shots

Not only are flu shots covered by Cigna, but you should have the opportunity to receive your flu shot at no cost by visiting a participating Cigna provider and meeting certain other restrictions of your plan.

Flu shots are just one of the preventive care services that you can expect to be covered in full by a Cigna Medicare Advantage plan. Other examples of preventive care covered by Cigna include:

  • Additional vaccines like hepatitis, measles, pneumococcal, shingles and more
  • Annual check-ups
  • Various screenings

Medicare Advantage plans are required by federal law to include at least all Medicare Part A and Part B coverage. And any services or items covered in full by Medicare must also be covered in full by Medicare Advantage plans.

Medicare Part B provides full coverage of the flu vaccine when administered by a health care provider who accepts Medicare assignment. And that means Medicare Advantage plans must do the same.

For more information about the flu and flu vaccine, consult our Complete Guide to the Flu Vaccine.

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