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Is The Shingles Vaccine Covered By Medicare Advantage Plans

Medicare Advantage Plans May Cover More Vaccines Than Original Medicare

Medicare & You: Vaccines

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.

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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.

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.

Company

Typical costs based on available plans in Charlotte, N.C. , Boston , and Los Angeles .

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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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Does Medicare Cover Shingles Vaccines In 2022

Shingles is a viral infection caused by the varicella-zoster virus . It produces a painful rash with fluid-filled blisters and typically shows up on one side of the body. The same virus that causes chickenpox causes shingles. Anyone who has had chickenpox in the past is at risk of getting shingles.

Shingles is a painful rash that occurs along the distribution of a nerve, called a dermatome, says Erum N. Ilyas, MD, a fellow of the American Academy of Dermatology and founder of AmberNoon. The virus lays dormant in the nervous system. Immunity likely plays a role in preventing the virus from reactivating. When immunity is low, the virus replicates and spreads down the nerve causing pain, inflammation, and blistering.

The Centers for Disease Control and Prevention recommends that adults older than 50 get the shingles vaccine. Shingles can cause long-term nerve pain and nerve damage. Getting two shingles vaccine doses two to six months apart has proven to be very effective at preventing shingles.

Shingrix is a brand-name shingles vaccine and is currently the only shingles vaccine available in the United States. Zostavax, a previous zoster vaccine, wasdiscontinued in 2020.

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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.

Does Medicare Pay For Shingles Shots

Does Medicare cover the shingles vaccine?

Heres the quick answer

Surprisingly, Original Medicare doesnt cover the shingles vaccine, even though it covers other vaccines like the flu vaccine and pneumonia shot.

On the other hand, Medicare Part Dor a Medicare Advantage plan that includes Part D coveragetypically does cover the vaccine.

The devil is in the details

Every Part D plan is different, so your copay for a shingles vaccine could vary from one insurance plan to another. For this reason, its always good to check your plans formulary to see which vaccines they cover and which tier those medications fall under.

Part D covers a lot more than the shingles vaccine, providing coverage for prescription medications. If you need the shingles vaccine and prescription drug coverage, see our guide on how to find the best Part D plan for you, or learn more about Part D first.

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What Vaccines Are Covered By Medicare

The following chart shows how some common vaccines are covered by Medicare.

Vaccine
Coronavirus 2019 – Part B You pay nothing for the vaccine, whether you receive 2 shots or only a single dose.
Influenza -Part B You pay nothing for 1 flu shot per flu season if your doctor accepts Medicare assignment.
Pneumococcal -Part B You pay nothing for 2 shots if your doctor accepts Medicare assignment.
Hepatitis B -Part B You pay nothing if youre at medium or high risk for Hepatitis B and your doctor accepts Medicare assignment.
-Medicare Advantage plans with drug coverage-Part D Coverage rules and costs vary by plan.
Tetanus -Medicare Advantage plans with drug coverage-Part D Coverage rules and costs vary by plan.

These are only a few of the most commonly recommended vaccines. Check with your doctor or health care provider if you have questions about a specific immunization or vaccine that is not listed here.

Medicare Part B also typically covers vaccines after youve potentially been exposed to a dangerous disease or virus. For example, your rabies shot may be covered by Medicare Part B if you are bitten by a dog.

Medicare Coverage For Shingles

Home / FAQs / Medicare Coverage / Medicare Coverage for Shingles

All Medicare prescription plans cover shingles vaccines. If you believe you may have shingles, Part B pays for a visit to the doctor.

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If your doctor prescribes antiviral or pain medications, Medicare prescription drug plans will usually cover them.

In the context below well discuss coverage and costs for everything relating to shingles with Medicare.

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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.

Fixing Medicare Vaccine Coverage Once And For All

Shingles vaccine offered in NKY

Nonetheless, barriers to vaccine access remain for seniors due to the separate benefit part placement of vaccines in Part B and D. In seeming acknowledgment of the above problem, Congress acted rapidly to provide for coverage of COVID-19 vaccines without cost sharing under Part B when it passed the Coronavirus Aid, Relief, and Economic Security Act in March 2020, a full eight months before the first vaccine was authorized for emergency use.

As early as 2007 and as recent as 2021, the Medicare Payment and Access Commission recommended moving the coverage of vaccines from Part D to Part B. In the 2007 report, MedPAC foresaw the challenges stemming not only from beneficiary OOP costs under Part D, but also the challenges of physician out-of-network status under Part D. While pharmacists have long been permitted to roster bill vaccinations under Part B, easing the hurdle of split benefit part placement, physicians continue to face difficulty in offering Part D vaccines. Because they are out of network, this makes it difficult to ascertain coverage and cost sharing information. This may lead to patients paying the full cost of vaccines up front and seeking reimbursement under Part D later. This exacerbates the already burdensome financial requirements that result in lagging adult vaccine offerings in physician offices.

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Who Is In Danger Of Getting Shingles

Anybody that has suffered from chickenpox, including children, is susceptible to shingles. Shingles, on the other hand, are most prevalent in people over the age of 50. Shingles are much more likely to happen as people age. People that have medical disorders that impair the immune systems function, such as tumors, leukemia, lymphoma, and human immunodeficiency virus infections, or that take medications that weaken the immune system, such as steroids and medicines administered during organ transplantation, are more likely to develop shingles.

Number Of Doses Required

Depending on the persons age, two or three doses of the vaccine are required for the best possible protection.

For people under 18 years of age, experts believe that two doses of HPV vaccine will produce a sufficient immune response.

Based on various studies, experts believe that these two vaccines will produce a stronger immune response to HPV types 16 and 18 than two doses of Gardasil® 9. HPV 16 is responsible for most HPV-related cancers, especially cancers that affect men. Furthermore, these two vaccines provide immunity against the seven other types of HPV targeted by the Gardasil® 9 vaccine.

People aged 18 or older need three doses of Gardasil® 9.

These vaccines are more effective when the person being vaccinated has never had a HPV infection. Since the infection usually occurs in the first years of sexual activity, the vaccine should ideally be given before the person becomes sexually active. These vaccines are nonetheless indicated for people who have already had a HPV infection or lesion.

  • Itching at the injection site, fever

The Cervarix® vaccine causes a little more pain, redness and swelling at the injection site than the Gardasil® 9 vaccine.

To date, over 300 million doses of HPV vaccines have been administered worldwide. According to current scientific data, no serious or unexpected problems are associated with these vaccines. No link has been found between this vaccine and certain serious diseases or deaths.

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Also Check: How Long Does Pain Last After Shingles

Whats The Cost Of The Shingles Vaccine

According to GlaxoSmithKline, manufacturer of Shingrix, the two-shot series costs people with Medicare Part D an average of $50 per shot.15

As of October 2021, discount-coupon company GoodRx lists Shingrix at around $160, which is about 23% off its reported average retail price of $206.73.16 It indicates that Medicare plans list Shingrix typically in Tier 3 of their formulary. 17

Ultimately, how much your vaccine costs depends on the Medicare prescription plan or Medicare Advantage plan you choose, the vaccine you get and the pharmacy or doctors office where you have it administered.

If the shingles vaccine cost is unaffordable for you, GlaxoSmithKline has a Patient Assistance Program GSK for You that may be able to help you with the cost.

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Who Should Not Get Hpv Vaccine

Does Medicare Cover the Shingles Vaccine in Decatur, IL?

Tell your doctor about any severe allergies. Some people should not get some HPV vaccines if:

  • They have ever had a life-threatening allergic reaction to any ingredient of an HPV vaccine, or to a previous dose of HPV vaccine.
  • They have an allergy to yeast .
  • They are pregnant.

HPV vaccines are safe for children who are mildly ill, like those with a low-grade fever of less than 101 degrees, a cold, runny nose, or cough. People with a moderate or severe illness should wait until they are better.

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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.

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.

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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.

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Prescription Drug Coverage And Shingles Treatment

Your doctor may prescribe antiviral drugs such as famciclovir, valacyclovir, and acyclovir. These drugs can help the rash heal more quickly and reduce the chance youll suffer serious side effects. If your pain is severe, your doctor may also write you a prescription for pain medications.

Medicare prescription plans typically cover both antiviral and pain medications, though the specifics will depend on your plan. You may have to pay a deductible or copay.

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Your doctor may also suggest over-the-counter remedies such as lidocaine patches and Tylenol. Prescription plans dont cover over-the-counter medications, even if your doctor recommends them.

Medicare Vaccine Coverage Through Part B

If you have Original Medicare Parts A and B, or a Medicare plan from a private insurance company, your medical coverage usually takes care of the most common immunizations. Private Medicare health plans also cover additional vaccines through their Part D benefit, which well talk about later in this article.

In some cases, your medical coverage will cover certain vaccines if youre at risk of getting a related disease or illness. If you have Original Medicare, its easy to check if your vaccine is covered. If you get your Medicare benefits through a private insurance company, contact them directly to see if your vaccine is covered.

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What Are The Possible Side Effects Of Hpv 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 HPV vaccines, or if after having a HPV vaccine you or your child have symptoms that worry you.

Common side effects of HPV vaccines include:

  • pain, redness and swelling where the needle went in

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