Who Should Get The Shingles Vaccine
Shingrix® is recommended for adults 50 years of age and older. This includes those who have had shingles or received Zostavax® II. You should wait at least 1 year before getting Shingrix® if you had shingles or received Zostavax® II.
Zostavax® II may be given to adults 50 years of age and older who cannot get Shingrix® due to a life-threatening reaction to a previous dose of the vaccine or to any part of the vaccine.
Tips For Getting Vaccinated At The Pharmacy
You’ll no doubt remember if you’re due for your annual flu shot. But for other vaccinations, it’s a good idea to check with your physician about what immunizations are recommended for you based on your age and medical history.
Pharmacists in all states are allowed to administer a long list of vaccinations, but state laws varyfor example, you can’t get hepatitis vaccines at the pharmacy in New York. Also, in some states, certain vaccines require a doctor’s prescription. When in doubt, check with your pharmacist.
According to Catizone, the following tips can help getting your vaccinations at the pharmacy go smoothly:
Which Medicare Providers Cover The Shingles Vaccine
All Medicare Plan D plans offer some level of coverage for the shingles vaccine. However, coverage varies by company, and your actual cost will depend on your plan details and if youve already met your deductible.
Youll get the best deal on shingles vaccine coverage with a Medicare plan from Aetna or Wellcare.
In both cases, a shingles vaccine dose costs less than $50, and the Part D plans are affordable, averaging $36 to $37 per month.
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Typical costs based on available plans in Charlotte, N.C. , Boston , and Los Angeles .
Find Cheap Medicare Plans in Your Area
Remember that coverage for the shingles vaccine is usually just one aspect of your prescription drug needs. And the best Medicare Part D plan for you is determined by its total performance, including how well its coverage matches your prescription needs.
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Saving On Pharmacy Vaccinations
Just like at your doctors office, pharmacies that offer vaccinations will file with your insurance.
Many vaccinations wont cost you anything if you have a private insurance plan through your employer or that you purchased on a state marketplace. Under the Affordable Care Act, private plans are required to fully cover the cost of recommended vaccinations for adults and children as preventive medical care.
Unfortunately, Medicare doesnt do as good of a job of covering recommended immunizations. Only flu, pneumonia, and hepatitis B vaccines are fully covered under Medicare Part B. Other vaccinations are treated like prescription drugs and are covered under Medicare Part D or Advantage plans. That means youll be responsible for paying any co-pays and deductibles required by your prescription drug plan.
If youre paying out of pocket, shop around to find the lowest price. When we checked, we found the lowest prices without insurance at Costco. For example, Pneumovax pneumonia vaccine cost $110 at CVS and Target, but just $97 at Costco pharmacies. And the dual Hepatitis A and B vaccine costs $145 at CVS, $150 at Walgreens , and $93 at Costco.
Another option if you are uninsured or paying out of pocket is to check with statewide free health clinics and community health centers, which offer free or low-cost preventive care and low-cost vaccinations. Find a clinic near you.
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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How Does The Shingles Vaccine Work
Shingrix is a recombinant vaccine: It is made in the lab using a protein found in the outer shell of the varicella-zoster virus. The vaccine prompts the body to produce an immune response against the virus protein. This way, the immune system will recognize and fight the virus when it reactivates in the body, preventing shingles. It does not contain a weakened form of the virus, like many vaccines do.
The largest clinical trial of the vaccine, which was done in 18 countries, found that it was 97.2% effective at preventing shingles in adults aged 50 years and older. In a later trial, completed at the same locations, vaccine efficacy was 89.8% in people 70 years of age and older.
In addition to preventing shingles from developing, the vaccine offers other benefits. The small percentage of people who got shingles after receiving the vaccine in clinical trials reported less pain than did those who got the disease and were not vaccinated. Additionally, the vaccine prevented shingles-related complications in all but one person.
You might have heard about a different shingles vaccine called Zostavax that was approved in 2006. But it is no longer available as of November 2020. Fortunately, Shingrix has higher efficacy than Zostavax.
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.
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Why Do You Need Shingles Shot
For older Americans, the shingles vaccine is an important way to protect against the herpes zoster virus. The virus can cause a painful rash and blisters. It can also lead to serious complications, such as pneumonia, brain damage, and even death.
It is recommended that adults over the age of 60 get the vaccine. If you are over the age of 60, talk to your doctor about whether the shingles vaccine is right for you and let an insurance broker find the best Medicare shingles vaccine plan.
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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What Are The Risks Of Shingles
About one in five people who get shingles will have severe pain after the rash goes away. This pain can last months or even years. This pain is known as post-herpetic neuralgia.
Rare complications of shingles include scarring, pneumonia, loss of hearing or vision, swelling of the brain and bacterial superinfections of the rash.
What Are The Shingles Vaccines
There are 2 vaccines, Shingrix® and Zostavax® II, that protect against shingles. Shingles is caused by the varicella zoster virus, which also causes chickenpox. Zostavax® II contains a weakened form of the virus while Shingrix® contains only a part of the virus. The vaccines are approved by Health Canada.
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How Much Does The Shingles Vaccine Cost
Shingles vaccines are not publicly funded in B.C. One dose of Zostavax costs about $200 each dose of Shingrix is about $150. Both vaccines are available at most travel clinics and pharmacies. Check with your health insurance provider to see if your plan covers the cost of these vaccines.Get immunized against shingles by making an appointment with your doctor, pharmacist or travel clinic.
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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What Are The Possible Reactions After The Vaccine
The shingles vaccines are very safe. Common reactions to the vaccines include headache as well as soreness, redness and swelling where the vaccine was given. Itching and a rash may also occur after getting Zostavax® II. Other reactions that may occur after getting Shingrix® include fever, muscle soreness, fatigue, shivering, nausea, vomiting and diarrhea.
It is important to stay in the clinic for 15 minutes after getting any vaccine because there is an extremely rare possibility, less than 1 in a million, of a life-threatening allergic reaction called anaphylaxis. This may include hives, difficulty breathing, or swelling of the throat, tongue or lips. Should this reaction occur, your health care provider is prepared to treat it. Emergency treatment includes administration of epinephrine and transfer by ambulance to the nearest emergency department. If symptoms develop after you leave the clinic, call 9-1-1 or the local emergency number.
It is important to always report serious or unexpected reactions to your health care provider.
If Youre 50 Or Older Get Shingrix
- Shingrix provides strong protection from shingles and long-term nerve pain.
- Get Shingrix even if you already had shingles, because you can get the disease more than once.
- Your risk of shingles and complications increases as you age.
- You need 2 doses of Shingrix. Get the second dose 2 to 6 months after you get the first dose.
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S For Getting Coverage For The Shingles Vaccine
If you currently only have Original Medicare, how can you get coverage for the shingles vaccine? First, you will need to sign up for a Medicare Advantage Plan or a Medicare Part D prescription drug plan to get coverage for the shingles vaccine. You should thoroughly research the plans available in your area. Eligibility for Advantage plans is based partly on where you live, so not all plans are available in all areas. An independent insurance agent can also help you choose the best Medicare Advantage plan for your needs.
Once you find a plan that meets your needs, you should check the coverage details to make sure that the shingles vaccine is covered. More than likely, you will need to meet a deductible before the plan pays for treatment. If you have already met your deductible and paid for the vaccine out-of-pocket, then you might be eligible for reimbursement for some of the charges. If you have questions about Medicare coverage for the shingles vaccine, there are many resources available at Medicare.gov. You can also give them a call at 1-800-633-4227 or TTY at 1-877-486-2048.
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Medicare Coverage For Shingles Vaccine
Shingrix is not the first shingles vaccine, but it is the only one currently on the market in the United States.Instead of using a live virus,the vaccine uses a protein from the virus to trigger an immune response. It is administered in two doses two to six months apart.
This shingles vaccine has been shown to decrease the risk for shingles by 97% for people between 50 and 69 years old and by 91% for people 70 and older. It reduces complications as well. The risk for post-herpetic neuralgia goes down by 91% and 89%, respectively, in those age groups.
Because the vaccine works well, it is important to know if and when Medicare covers it.
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Is The Shingles Vaccine Covered By Medicare And Can I Get It At Cvs
Because the shingles vaccine requires two doses, if you have to pay full price around $400 total it may approach the $445 maximum Part D deductible that Medicare allows for 2021.
If thats the case, you may want to consider getting your vaccine early in the year. This way you dont have to worry about your deductible resetting in a new plan year soon after meeting it. You should discuss the risks and benefits of this strategy with your healthcare provider.
As far as going to CVS Pharmacy or CVS in Target to get your shingles vaccine, this is definitely an option. You can always call ahead or go online to schedule same-day appointments, or go in on a walk-in basis at many locations.
How Well Does Shingrix Work
Two doses of Shingrix provide strong protection against shingles and postherpetic neuralgia , the most common complication of shingles.
- In adults 50 to 69 years old with healthy immune systems, Shingrix was 97% effective in preventing shingles in adults 70 years and older, Shingrix was 91% effective.
- In adults 50 years and older, Shingrix was 91% effective in preventing PHN in adults 70 years and older, Shingrix was 89% effective.
- In adults with weakened immune systems, Shingrix was between 68% and 91% effective in preventing shingles, depending on their underlying immunocompromising condition.
In people 70 years and older who had healthy immune systems, Shingrix immunity remained high throughout 7 years following vaccination.
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What Are The Possible Side Effects Of Shingles Immunisation
All medicines and vaccines can have side effects. Sometimes they are serious, most of the time theyre not.
For most people, the chance of having a serious side effect from a vaccine is much lower than the chance of serious harm if you caught the disease.
Talk to your doctor about possible side effects of shingles vaccines, or if you have possible side effects that worry you.
Common side effects of shingles vaccines include:
- pain, redness, swelling or itching where the needle went in
Serious reactions to immunisation are rare. With Zostavax® vaccination, very rarely a generalised chickenpox-like rash may occur around 24 weeks after vaccination. This may be associated with fever and feeling unwell. This rash may be a sign of a serious reaction to the virus in the vaccine. Seek medical attention and inform of recent Zostavax vaccination if you experience this reaction.
The Consumer Medicine Information links in How do you get immunised against shingles? list the side effects of each vaccine.
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.
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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.*
How Do You Get Immunised Against Shingles
You can only get the shingles vaccine on its own, not as a combination vaccine. It is given as a needle.
Shingles vaccines include:
Note the Zostavax vaccine contains a small amount of the live virus. Some people may not be able to receive a live vaccine for medical reasons, please discuss with your doctor or immunisation provider for further information.
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