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.
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.
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
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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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What Are My Options For The Shingles Shot And How Does It Work
As of November, 2020, there is only one shingles vaccine available in the United States. This goes by the trade name Shingrix.
Shingrix was approved by the FDA in . It is more than 90 percent effective at preventing shingles and postherpetic neuralgia after two doses of the vaccine.
An earlier vaccine, Zostavax, is no longer in use in the United States as of November 18, 2020. Zostavax first got FDA approval in 2006. It was about 51 percent effective at preventing shingles and 67 percent effective at preventing PHN.
How Much Does The Shingles Vaccine Cost With Medicare
Most people who are enrolled in Medicare Part D pay less than $50 per dose for Shingrix, according to the vaccine’s manufacturer GlaxoSmithKline. However, your costs will vary based on the plan’s details and if you’ve already met your deductible amount by purchasing other prescription drugs.
For example, some seniors can get the shingles vaccine for free because it’s 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 hasn’t been met.
If you don’t have a prescription drug plan or you haven’t met your plan’s deductible, the retail cost for the shingles vaccine is $162 per shot. 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 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.
Is There A Downside To The Shingles Vaccine
Though the vaccine is deemed safe by the U.S. Food and Drug Administration , there are certain conditions in which the vaccine may not be safe for you.
- The shingles vaccine has only been tested in adults over age 50 years and immunocompromised adults above 18 years thus, there is no recommendation for the vaccine for younger ages by the FDA.
- You should not get the vaccine if you have had a severe allergic reaction to a previous Shingrix dose.
- You have tested negative for immunity to varicella-zoster virus .
- You have an active shingles infection.
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About The Shingles Vaccine
The Centers for Disease Control and Prevention recommends that healthy adults over the age of 50 get the shingles vaccine because it’s the only way to protect against the disease and its associated side effects. The risk of getting shingles increases as you age or if you have a weakened immune system. Always consult your doctor to find out if the shingles vaccine is right for you.
The CDC-recommended vaccine, Shingrix, is a recombinant zoster vaccine that has two doses administered within six months of each other. It’s classified as a Tier 3 drug by most insurance companies, which means it’s a brand-name pharmaceutical with a higher copayment than a Tier 1 or 2 drug.
Use the Shingrix vaccine locator to find where the shingles vaccine is being offered, and check with your Medicare Part D or Medicare Advantage provider to see which locations give you the lowest price.
What Parts Of Medicare Cover The Shingles Vaccine
- Medicare Part C. Medicare Advantage is a plan you can buy through a private insurance company. It may offer additional benefits not covered by original Medicare, including some preventive services. Many Medicare Advantage plans include prescription drug coverage, which would cover the shingles vaccine.
- Medicare Part D. This is the prescription drug coverage portion of Medicare and typically covers commercially available vaccines. Medicare requires Part D plans to cover the shingles shot, but the amount it covers can be very different from plan to plan.
Making Sure Youre covered
There are a few steps you can take to make sure your shingles vaccine is covered if you have Medicare Advantage with drug coverage or Medicare Part D:
- If your doctor cant bill your plan directly, ask your doctor to coordinate with an in-network pharmacy. The pharmacy might be able to give you the vaccine and bill your plan directly.
- File your vaccine bill for reimbursement with your plan if you cant do either of the options above.
If you have to file for reimbursement, youll have to pay the full price of the shot when you get it. Your plan should reimburse you, but the amount covered will vary based on your plan and if the pharmacy was in your network.
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What Is Shingles And How Do You Catch It
Shingles is a painful skin rash that forms on one side of the body. It is caused by the same virus that causes chickenpox, the varicella-zoster virus. Shingles can affect people who have had chickenpox, even if they had the illness long ago.
Once youve had chickenpox, the virus becomes inactive in the body and can reactivate years later. The virus can remain inactive in your nerve roots for many years, and then wake up and travel down the path of a sensory nerve to the skincausing shingles. You may develop shingles more than once in your lifetime.
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What Everyone Should Know About The Shingles Vaccine
CDC recommends that adults 50 years and older get two doses of the shingles vaccine called Shingrix to prevent shingles and the complications from the disease. Adults 19 years and older who have weakened immune systems because of disease or therapy should also get two doses of Shingrix, as they have a higher risk of getting shingles and related complications.
Your doctor or pharmacist can give you Shingrix as a shot in your upper arm.
Shingrix provides strong protection against shingles and PHN. In adults 50 years and older who have healthy immune systems, Shingrix is more than 90% effective at preventing shingles and PHN. Immunity stays strong for at least the first 7 years after vaccination. In adults with weakened immune systems, studies show that Shingrix is 68%-91% effective in preventing shingles, depending on the condition that affects the immune system.
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Does Medicare Cover Shingles Shots At Pharmacies
Always check with your insurance company, but getting your shingles shot at a doctors office may not be covered the same as if you get it at a pharmacy. Because its a Part D service, shots given at pharmacies are applied directly to your Part D plan just like other prescription drug costs. Does Medicare pay for shingles shot if a doctor gives it? Probably, but you may need to pay upfront and submit a claim for reimbursement.
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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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Vaccines Covered By Medicare Part B
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.
Do I Have To Pay For Vaccines With Medicare
You pay nothing for vaccines covered by Part B flu, pneumonia and Hepatitis B as long as your provider accepts Medicare.
Your cost for vaccines covered by Part D will depend on your specific plan. You may pay a copay or coinsurance, but it will depend on your plan and the provider.
The location where you get vaccinated may also affect your cost. For example, your costs may be lower if you get a vaccine at a pharmacy versus in a doctors office.
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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.
How Can You Save On The Cost Of The Shingles Vaccine
These five tips can help you pay less for a shingles vaccine.
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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.
Can You Get The Shingles Vaccine For Free
The shingles vaccine is manufactured by GlaxoSmithKline Biologicals, a pharmaceutical company. GSK has a patient assistance program that may provide the vaccine to you at no cost if you meet these eligibility criteria:
- You dont have prescription drug coverage or a Part D plan and have spent at least $600 during the calendar year
- You are an adult, age 19 or older
- You live in the U.S., Puerto Rico, or the District of Columbia
- You dont qualify for Puerto Ricos Government Health Plan
- Your maximum monthly gross income does not exceed certain limits, depending on where you reside and your household size
- You apply through your health care provider, who will register for the patient assistance program and submit your application
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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.