Tuesday, July 16, 2024

Does Medicare Advantage Cover Shingles Vaccine

Does Medicare Cover The Shingles Vaccine

Medicare & You: Vaccines

While Original Medicare does not cover the shingles vaccine, called Shingrix, some Medicare Advantage plans and some Medicare Part D plans may offer coverage for the vaccine.

Medicare Part B covers a small handful of vaccines for the flu, Hepatitis B and the pneumococcal vaccine.

But because vaccines are categorized as a drug, these shots are typically covered by the prescription drug benefits offered by Medicare Part D and Medicare Advantage plans.

What Are My Options For The Shingles Shot

The two options for the shingles shot are Zostavax and Shingrix. Zostavax, according to the Mayo Clinic, protects against shingles for about five years. Itâs a live vaccine given as a single shot in the upper arm. The Zostavax shingles shot is recommended to adults age 60 and over which reduces the risk of developing shingles by 51%, according to the Centers for Disease Control and Prevention .

Studies suggest that Shingrix offers protection against shingles for more than five years. Itâs a nonliving vaccine given in two doses. The Shringrix shingles shot is recommended for adults age 50 and older.

The Shingrix shingles vaccine is more effective than Zostavax. Shingrix is more than 97% effective in preventing shingles in adults 50 to 69 years old after two doses. The Shingrix shingles vaccine is 91% effective in preventing shingles in adults age 70 and older, according to the CDC.

How To Save Money On Vaccines

If youre uninsured or having trouble paying for your vaccines, talk to your CVS pharmacist.

GoodRx offers discounts on vaccines as well as medications. You can print or show the CVS pharmacist a GoodRx coupon. For the shingles vaccine Shingrix, for example, you can save as much as 22% off the average retail price. Another GoodRx coupon can help save as much as 36% off a Tdap vaccine.

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Can You Get Shingles If You Had The Chickenpox Vaccine

It depends. Anyone who has ever had chickenpox is susceptible to shingles. When the chickenpox virus comes out of hiding and reactivates, it causes numbness, tingling, blisters, and sometimes flu-like symptoms. If you never had chickenpox because you were vaccinated, you run a very low risk of getting shingles.

Vaccines Covered By Medicare Part B

Do Seniors Pay For Shingles Vaccine

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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S Of Medicare That Cover The Shingles Vaccine

The part of Medicare that covers the vaccine is your Medicare Part D plan or the Medicare prescription drug plan. Remember that a Part D plan is optional, so you might not be enrolled in one of these plans unless you decide to sign up for coverage. Part D typically provides coverage for prescription drugs, and the shingles vaccine is one drug that most plans cover. If you are enrolled in a Medicare Advantage plan, then your plan likely includes prescription drug coverage that will cover the vaccine. Since these Advantage plans are insurance plans administered by private insurance companies, you should contact your provider if you have any specific coverage questions or need help with the details of your plan. Many people also wonder if Medicare covers eye exams. These Medicare Advantage plans often include additional benefits like dental and vision coverage.

Original Medicare will not cover the shingles vaccine. Medicare Part A, or hospital insurance, pays for hospital stays and inpatient care. Vaccines and preventive services are never covered under Medicare Part A. Medicare Part B, which is more traditional medical insurance, pays for doctors office visits, outpatient care, and many preventive services. Part B will cover many immunizations, like the flu vaccine, pneumonia vaccine, and hepatitis B vaccine. Unfortunately, Part B does not cover the shingles vaccine. If you are not enrolled in a Part D plan, then this vaccine will be an out-of-pocket cost for you.

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

Recommended Reading: How Long Are You Contagious With Shingles

How To Get Free Shingles Vaccines

If youre covered by a private health plan other than Medicare, such as through your employer or the healthcare exchanges under the Affordable Care Act, virtually all recommended vaccines are required by law to be provided at no cost to you. In that case, this means you can get a free shingles vaccine, as well as any other vaccine recommended by the CDC.

If you want to avoid any out-of-pocket cost for a shingles vaccine, you should consider getting the vaccine before switching from your private insurance to Medicare.

If youre already on Medicare and are a beneficiary of a Part D plan or an Advantage Plan that includes prescription drug coverage, you will pay less for a vaccine under the plan after you meet the plans deductible in a given year.

In addition, some Medicare Part D beneficiaries qualify for extra help provisions, which aid in paying for their monthly premiums, annual deductibles, and co-payments related to Medicare prescription drug coverage.

Medicare Advantage Plans May Cover More Vaccines Than Original Medicare

Shingles vaccine is recommended for healthy older adults

Medicare Advantage plans are sold by private insurance companies as an alternative to Original Medicare.

Every Medicare Advantage plan must provide the same hospital and medical benefits as Medicare Part A and Part B, and most plans include Medicare prescription drug coverage.

MAPDs must help cover a number of commercially available vaccines that arent covered by Original Medicare when reasonably and medically necessary to prevent illness. However, specific rules of administration and costs will vary depending on the Medicare Advantage plan you enroll in.

A licensed insurance agent can help you compare Medicare Advantage plans in your area, including what vaccinations may be covered.

Find Medicare plans that cover your vaccinations

Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

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.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelors degree in journalism.

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What Should I Do If I Have Shingles

If you think you may have shingles, see a doctor as soon as possible and get a professional diagnosis. While some cases are mild and may clear up on their own without treatment, other cases can cause severe pain and require medication to manage.

Its also important to take steps to avoid spreading the virus. The Centers for Disease Control recommends keeping the rash covered and washing your hands often. Avoid touching the rash as much as possible and avoid contact with people who may be at risk, including:

  • Premature infants
  • Pregnant women who have not had chickenpox or been vaccinated for it
  • People with HIV or weakened immune systems due to cancer treatment, organ transplant, or immunosuppressive drugs

Your doctor may recommend antiviral drugs, or simply treating the rash with over-the-counter medication such as calamine lotion to soothe the pain of the blisters. Treatment can reduce the pain and duration of the symptoms, but doesnt cure the disease altogether.

For many seniors, the most painful part of shingles isnt the rash, but post-herpetic neuralgia, which can last a year or more in some cases. Although not everyone who gets shingles will experience post-herpetic neuralgia, it can have a big impact on those that do. Some people develop chronic pain that lasts for years and affects their quality of life.

What Shingles Vaccines Are Available

According to the Centers for Disease Control and Prevention , there are 2 vaccines licensed and recommended to prevent shingles in the U.S.: Shingrix and Zostavax.2 The CDC recommends that healthy adults 50 years and older get 2 doses of Shingrix, separated by 2 to 6 months, to prevent shingles and the complications from the disease.3

Read Also: How Long Does A Case Of Shingles Last

What Vaccines Does Wellcare Pay For

All Medicare Advantage plans including Wellcare Medicare plans are required by law to cover all the same vaccines that are covered by Medicare Part B. This includes vaccinations for:

  • Flu Flu shots are typically covered once per year during flu season
  • Pneumococcal Coverage is for a one-time vaccine given in two doses, generally one year apart.
  • Hepatitis B Coverage is for a one-time vaccine given in two to four doses over one to six months for those at medium to high risk, including those with diabetes.
  • COVID-19 Coverage includes the two-dose vaccine from either Pfizer or Morderna and the single-dose vaccine from Johnson & Johnson. Medicare covers a COVID-19 vaccine booster shot at least six months after completing the two-dose cycle of the Pfizer or Moderna vaccines or at least two months after the Johnon & Johnson vaccine.

Additional vaccines are covered if you have been exposed to a harmful virus or bacteria. For example, a tetanus shot would be covered if you stepped on a rusty nail, or a rabies shot would be covered if you were bitten by a stray dog.

If your Wellcare plan includes prescription drug benefits, you may have coverage for some additional vaccines. Some of the vaccines covered by the prescription drug portion of a Wellcare Medicare Advantage plan may include:

What Vaccines Do Medicare Advantage Plans Cover For Seniors

National Shortage of Shingrix (Shingles Vaccine)

August is National Immunization Awareness Month , a time to talk about the importance of vaccination for people of all ages. Most of us received vaccinations as children. As adults, we still need to keep up to date. The Centers for Disease Control and Prevention says all adults need the influenza vaccine each year plus the Tdap vaccine. In addition, you may need other vaccines based on other factors such as age, health conditions, job, lifestyle or travel habits. Its important to have conversations with your healthcare provider about vaccines and which are right for you.

As you approach the age of 65, or if you are 65+, you might wonder what vaccines you need and if they are covered. We can answer a few common questions you might have.

Read Also: Does Medicare Cover The Shingrix Shingles Vaccine

Medicare Part D And Shingles Vaccine

Medicare Part D plans help cover the cost of prescription drugs, including vaccinations for shingles.

Shingrix and Zostavax are the two commercially available shingles vaccines, and they tend to cost about $190 to $240 per shot however, a Medicare Part D plan can cover this cost. Alternatively, a Medicare Advantage plan that includes Part D coverage can also offer similar benefits.

That said, most Medicare Part D plans will have a deductible. Until you reach this deductible, youll be responsible for paying for any vaccinations or other drugs.

Does Medicare Cover The Hepatitis B Vaccine

Medicare Part B and Medicare Advantage plans will cover injection of the Hepatitis B vaccine if you are considered at medium or high risk for Hepatitis B.

You may have an increased risk if:

  • You have hemophilia
  • You live with another person who has Hepatitis B
  • You work in health care and have frequent contact with blood and other bodily fluids

Your doctor can help you determine if youre at increased risk for contracting Hepatitis B.

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Medicare And The Shingles Vaccine

In most cases, Original Medicare will not cover vaccinations and immunizations. The exceptions to this rule are vaccines for influenza, pneumonia, hepatitis B, and COVID-19. Part B can also cover vaccinations needed following exposure to a dangerous virus or disease. This could include tetanus shots after scraping yourself on a rusty nail or rabies shots after getting bitten by a dog.

Other vaccinations, including those for shingles, will require you to either pay out of pocket or use a different form of coverage such as private insurance or Medicare Part D.

Will Medicare Offer Free Shingles Vaccines

Shingles Vaccine Info

Concerned that the complicated and sometimes expensive Medicare vaccine coverage system is resulting in low vaccination rates among Medicare beneficiaries, bipartisan members of Congress have introduced legislation that would require all recommended vaccines to be covered under Part B at no cost to beneficiaries. This would include vaccines for both shingles and the combination vaccine for tetanus, diphtheria, and pertussis .

According to bill sponsor Senator Shelley Moore Capito , before the pandemic, the U.S. spent more than $15 billion every year treating diseases that could have been prevented by vaccines.

The Protecting Seniors Through Immunization Act would also require beneficiaries be given information about vaccines and require a study of vaccination rates among Medicare patients.

In addition, President Bidens proposed 2023 budget recommends consolidating vaccine coverage under Medicare Part B, making more preventive vaccines available at no cost to Medicare beneficiaries. The budget also establishes a new Vaccines for Adults program to give uninsured adults free access to all recommended vaccines

Researchers at Avalere Health, a consultancy, found that out-of-pocket costs for vaccines are common among Medicare beneficiaries. As of 2020, Part D plans require a copayment for recommended vaccines 87% of the time, with an average copayment of $47 and a maximum as high as $100.

Read Also: How Do Shingles Start And What Does It Look Like

Does Medicare Cover Pneumonia Shots

Medicare Part B typically covers pneumonia shots, which help prevent certain types of pneumonia.

Medicare Advantage plans also cover pneumonia shots. Many Medicare Advantage plans also cover prescription drugs and other benefits that Medicare Part A and Part B don’t cover.

Medicare typically covers 100 percent of the Medicare-approved amount of your pneumococcal vaccine .

Before getting your pneumonia shot, verify with your doctor that it is 100 percent covered by Medicare.

The Centers for Disease Control and Prevention recommends PPSV23 pneumococcal vaccinations for all adults who are 65 years of age or older.

There are currently two pneumococcal vaccines that have been approved for use for the prevention of pneumonia. Both vaccines are covered under Medicare Part B however, the order in which you receive them matters. Talk to your health care provider to learn more.

Does Medicare Advantage Cover A Shingles Vaccine

If you have a Medicare Advantage plan with prescription coverage, then the shingles vaccine will be covered. If you dont have prescription coverage, youll have to pay for the vaccine yourself.

As with traditional Medicare, the cost of the vaccine can vary by plan. Youll save money by getting your vaccine from a pharmacy in your plans network.

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Who Needs The Shingles Vaccine

According to the Centers for Disease Control and Prevention , the Advisory Committee on Immunization Practices recommends the shingles vaccine for people aged 50 and older. It is a manufactured inactivated vaccine intended to prevent shingles. The vaccine is administered in two separate doses given by intramuscular injection, separated by two to six months.

The shingles vaccine is considered an important vaccine for seniors because our immune system weakens as we age. The recommendation for vaccination is based on the potential severity of symptoms and long-term complications.

A shingles vaccine called Zostavax is no longer used in the U.S. as of November 2020. If you received that vaccine, the CDC recommends talking with your doctor about getting the Shingrix vaccine.

The CDCs fact sheet on shingles lists these risks and potential complications:
  • About one in three people will develop shingles at some point in their lifetime
  • More than 99% of people in the U.S. born before 1980 have had chickenpox even if you dont remember it which poses risk for shingles
  • Your risk for getting shingles and complications from it increase as you get older
  • About one in 10 people who get shingles develop ongoing nerve pain
  • Shingles may lead to other complications involving the eye, including blindness rarely, shingles may lead to pneumonia, hearing problems, brain inflammation, or death

Shingrix is more than 90% effective at preventing shingles, but it does not prevent chickenpox.

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