Medicare And The Shingles Vaccine: Are You Covered
The shingles vaccine is covered through Medicare Part D or Medicare Advantage as part of your prescription drug benefits. In 2022, your actual costs for the vaccine depend on the specifics of your plan.
Beginning Jan. 1, 2023, all vaccines will be free under Medicare Advantage or Part D including shingles. No matter your plan, you’ll pay no deductible, copay or other costs for a shingles vaccine.
In 2022, you could pay less than $50 per shingles shot with a Medicare Part D plan from Aetna or Wellcare. If you don’t have prescription drug coverage, the full price for two doses of the Shingrix vaccine is $324, and several cost-saving options can help you get Shingrix for less.
Find Cheap Medicare Plans in Your Area
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.
Editor’s note: This article was originally published on Jan. 1, 2014. It has been updated with the latest information regarding Medicare coverage in 2020.
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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Which Vaccines Does Medicare Cover
Medicare covers most vaccines. Some are covered by Part B, and some are covered by Part D.
Getting the vaccines you need is one of the most important things you can do for your health and for the health of those around you. Vaccines are your first line of defense against a number of infectious diseases. If you dont get sick, then you cant infect your loved ones, your friends or others in your community.
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.
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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 Are The Benefits Of The Shingles Vaccine
The shingles vaccines are the best way to protect you from getting shingles. The vaccines have been shown to reduce the risk of getting shingles by 50% for Zostavax® II, and to more than 90% for Shingrix®.
For those who still get shingles after being immunized, the vaccines can reduce pain, including the type of pain that lasts after shingles.
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Can I Get Shingles If Ive Had Chickenpox Already
Yes. After you have chickenpox, the virus stays in your body. It might go many decades before resurfacing or never come back at all. As you get older, the chance of the virus reappearing as shingles becomes more significant and can also lead to other negative health effects.
It is rare but possible to get shingles more than once.
What Are The Complications Of Shingles
The most common and lasting complication of shingles is nerve pain, whats called postherpetic neuralgia , which can last for months or even years, long after the rash has cleared up. According to the CDC, between 10% and 18% of people whove had shingles will develop PHN.
PHN is a stabbing or throbbing pain or weakness where the shingles rash had been. The risk increases with age and the pain lasts longer and is more severe than in younger people.8
In rare cases, shingles can develop into pneumonia, hearing problems, blindness and brain inflammation.9 Only 1% to 4% of people with shingles are hospitalized for complications, though these are typically older adults and people whose immune systems are weak or suppressed, and fewer than 100 people die from shingles each year.10
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Who Should Get Zostavax
People 60 years of age or older should get shingles vaccine . They should get the vaccine whether or not they recall having had chickenpox, which is caused by the same virus as shingles. Studies show that more than 99% of Americans aged 40 and older have had chickenpox, even if they dont remember getting the disease. There is no maximum age for getting shingles vaccine.
Two vaccines are licensed and recommended to prevent shingles in the U.S.. Zoster vaccine live has been in use since 2006. Recombinant zoster vaccine , has been in use since 2017 and is recommended by ACIP as the preferred shingles vaccine.
Even if you have had shingles, you can still receive shingles vaccine to help prevent future occurrences of the disease. There is no specific length of time you must wait after having shingles before receiving shingles vaccine, but generally you should make sure the shingles rash has disappeared before getting vaccinated. The decision on when to get vaccinated should be made with your healthcare provider.
Talk with your healthcare provider if you have questions about shingles vaccine. Shingles vaccine is available in doctors offices and pharmacies. To find doctors offices or pharmacies near you that offer the vaccine, visit Zostavax or HealthMap Vaccine Finder.
Don’t Overpay: Advice For Medicare Patients
Three out of four Americans eligible for the shingles vaccination still havent gotten it, according to the CDC. Not surprisingly, a 2015 report from the National Vaccine Program found that one of the main reasons adults skip recommended vaccines is the cost.
If youve been putting off getting your shingles shot because you were quoted a high price, check your Part D plan. You may be able to get it for less.
Confusion about insurance coverage for the vaccine can sometimes result in patients paying more than they should, Avitzur says.
Dont delay, as the consequences of shingles can be devastating, advises Avitzur, a neurologist who has seen firsthand the painful effects of lingering nerve damage.
Your best bet may be to get the shot at a pharmacy in your drug plans network. Youll still need to get a prescription from your doctor, but the pharmacy will bill your insurance company and youll pay the lowest out-of-pocket costs available under your plan.
If you would like to get vaccinated at your doctors office, ask up front about the cost. Does your doctor charge more to administer the shot than your plan allows? If so, youll be on the hook for the difference. Also see whether the office will bill your Part D or Medicare Advantage plan directly or work with a pharmacy in your network to handle the billing.
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You Can Also Refer The Member To The Pharmacy For The Vaccine
As a preventitive measure, blue cross blue shield of massachusetts members with our pharmacy coverage who are aged 60 and older can now go to a participating retail pharmacy to get a shingles vaccine at no cost. Preventive care plans & guidelines. If your plan includes the pharmacy vaccine network, covered benefits for flu, pneumonia and shingles shots are available at participating pharmacies for blue cross and blue shield of alabama.
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.*
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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
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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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.
Does Blue Cross Blue Shield Ppo Cover Shingles Vaccine Covid 2022
Does Blue Cross Blue Shield Ppo Cover Shingles Vaccine Covid 2022. Details drug coverage for blue cross and blue shield of nebraska blue cross blue shield nebraska ma access ppo in nebraska. Medicare advantage plans with prescription drug coverage and part d plans may cover the shingrix vaccine, but that does not necessarily mean it will be free.
Does blue cross blue shield ppo cover shingles vaccine covid 2022. Until recently, the only vaccine available for shingles was zostavax which is 51%. In this section of our coronavirus resource center, we share information you can trust and answer questions about the vaccines.
Herpes zoster , two doses for adults 50 years and older or one dose for adults 60 years and older hpv, two or three doses depending on your age when you received your first shot. Original medicare does not cover the shingles vaccine , but medicare part d generally covers a shingles vaccine.
zostavax 60 years and older Initially, the federal government will pay for the vaccine.
The cost of vaccines and shots depends on two factors: Without insurance, you may pay $155 or more per.
Routine vaccinations are quick and easy to get, and they protect your health for years. Original medicare does not cover the shingles vaccine , but medicare part d generally covers a shingles vaccine.
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Coverage For The Shingles Vaccine
by Patricia Barry, AARP Bulletin
Q. Does Medicare cover the shingles vaccine?
A. Yes, but not in the way you might expect.
Other common vaccines are covered under Medicare Part B. In other words, you get them in a doctors office, then the doctor bills Medicare andin the case of flu and pneumonia shotsMedicare picks up the full tab.
But the shingles vaccine is covered under the Part D prescription drug program. That means you must be enrolled in a private Part D plan , get the vaccine through your plan and pay whatever share of the cost that your plan requires.
You shouldnt have any problem obtaining the shingles vaccine through your drug plan. Under Medicare regulations, all Part D plans must cover it.
But there are some pitfalls to watch out for in terms of paying for the shingles shot, depending on where you receive it:
* If youre vaccinated at a pharmacy, make sure its one that is in your Part D plans pharmacy network. Otherwise, the shot will cost you more than the plans normal copayment, perhaps even full price.
* If youre vaccinated in a doctors office, make sure the doctor can bill your plan directly through its computer billing process, or can work through a pharmacy in your plans network that can also bill the plan directly. Otherwise, youll have to pay the entire bill upfront and then claim reimbursement from your plan.
Patricia Barry is a senior editor at the AARP Bulletin.
Medicare Coverage And Payment
Medicare covers initial pneumococcal vaccine and different, second pneumococcal vaccine one year after the first is administered, effective February 2, 2015. See Modifications to Medicare Part B Coverage of Pneumococcal Vaccinationspdf iconexternal icon.
Medicare Part B will pay for the following vaccines:
- Influenza vaccine
Read Also: What Shingles Rash Looks Like
What Is Shingles And How Is It Related To Chickenpox
Shingles is a reactivation of the varicella-zoster virus in the body. This virus is responsible for chickenpox. As you age, the risk of developing this painful rash-like condition increases, leading many people to seek preventive immunization from its potentially severe effects.
As far as symptoms go, shingles causes a painful rash that may appear as a strip of blisters on the trunk of the body. The blisters continue to form over three to five days, eventually drying and forming a scab-like layer.
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
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