Who Should Be Vaccinated With Shingrix
The Shingrix vaccine is recommended for those 50 years of age and older who are in good health.
You should get the Shingrix vaccine even if:
- Youve had shingles already.
- Youve been previously vaccinated with Zostavax . If youve been vaccinated with Zostavax, wait at least eight weeks before getting vaccinated with Shingrix.
- You dont know for sure if youve ever had chickenpox.
Ask your healthcare provider, who knows your entire health history if getting this vaccine is right for you.
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Am I Contagious If I Have Shingles
Shingles cannot be passed from one person to another. But someone who has never had chickenpox can contract VZV from a person with active shingles. They would then develop chickenpox, not shingles.
Only direct contact with fluid from shingles blisters can transmit the virus. Keep shingles blisters covered with a fluid absorbent dressing to prevent others from contracting the virus.
Does Medicare Pay For The Shingles Shot
If you have Medicare with a separate Part D plan, your prescription coverage will include shingles shots. Several companies sell prescription plans, and each has its own deductibles, copays, and network of preferred pharmacies.
- If you get your shot at a preferred pharmacy, your pharmacy will bill Medicare, and youll pay any deductibles or copays.
- At a pharmacy outside your plans preferred network, youll pay more.
- If you get a shot at your doctors office, your doctor may be able to work with a pharmacy to bill Medicare directly. Or you may have to pay up-front and ask Medicare to reimburse you. Be aware that your doctors fee for administering the vaccine may be more than your prescription plan will pay.
Often the most cost-effective way to get a shingles vaccine is to get a prescription from your doctor and then go to a pharmacy in your plans network to get your shot.
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Why Doesnt Medicare Cover The Shingles Vaccine As Free For All Seniors
Many people think that a vaccine thats 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 isnt a generic alternative. This could mean that your out-of-pocket costs are higher than for other medications.
What You Can Do To Help Recover From Shingles
There is no cure for shingles, but there are medications, including antiviral medications, such as acyclovir or valacyclovir, to help fight the infection.
While your shingles is active, you should:
- Rest and relax. Try moderate activities, such as walking and listening to music that can help take your mind off the pain. For severe pain, your doctor may prescribe narcotic pain relievers, corticosteroids, and anticonvulsants.
- Wear loose-fitting clothes.
- Keep the rash clean and dry. Do not cover it or use ointments, which can prevent the blisters from bursting and beginning to scab over.
- Try cool compresses, calamine lotion, or an oatmeal bath to ease the itching and pain of the rash.
- Dont share bedding, clothing or towels in order to avoid spreading the infection while you have blisters.
There are effective vaccinations available to prevent shingles, so if you have had chickenpox, talk with your healthcare provider about getting protected from shingles.
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Tingling Pain Or Numbness
During the first stage of shingles, before anything appears on your skin, a particular area of your body may begin to feel different. “When a shingles outbreak is starting, you may feel itching, burning, or pain,” Kim says. Often you will feel this on only one side of your body.
The initial signs of shingles may feel different for each person. In some cases, shingles can cause intense sensitivity, making it painful to even wear clothes over your skin, while in other cases, your skin may feel numb.
Who Is At Risk
If you’ve had chickenpox, you are more susceptible as you age. About 50% of people who live to age 85 will have had some shingles event in their lives. Shingles can develop for a variety of reasons, especially for those:
- Over the age of 50, with increasing risk with each decade
- With a weakened immune system, such as those with cancer, HIV, transplant recipients, or patients receiving chemotherapy
- With an autoimmune disease
- Who may have a weakened immune system due to trauma or illness
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What Is Shingles And What Causes It
The varicella-zoster virus that causes chickenpox is the same virus that causes shingles. When you’ve had chickenpox as a child or teenager, the physical signs disappear as your body fights off the virus. However, the virus always remains in your body and can reactivate as you age.
For some, the virus stays in the body quietly in a portion of your spinal nerve root called the dorsal root ganglion. For others, the virus can become reactivated and develop into shingles.
The Stages Of Shingles Recovery
After the rash develops, which usually appears on only one side of the body, it forms blisters. You may feel like you have the flu or a mild fever. As you recover, you will typically go through these stages:
- Blisters begin to burst or weep about 5 days after they develop, and lasts from 7 to 10 days. You should take time off from work and other activities during this period, because you can spread the virus to others through the fluid in the blisters. Otherwise, you can return to work when you feel comfortable doing so.
- The blisters will scab over and begin to heal, which takes from 1 to 3 weeks, unless the rash is on your scalp in which case it can take several months.
- As they heal, the blisters become smaller and less painful, generally over a period of 3 to 5 weeks.
- About 10 to 15% of people with shingles will develop chronic nerve pain, which can be severe. Sensitivity to touch at the site of the rash is possible. The older you are, the more likely it is you will develop this disorder, called post-herpetic neuralgia, or PHN. The pain often lessens over time. Available treatments include anti-inflammatory injections, nerve blocks, certain tricyclic antidepressants, or capsaicin cream, which is made from chili peppers and can help ease nerve pain.
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What Vaccines Does Medicare Part D Cover
Medicare Part D is prescription drug coverage for Medicare beneficiaries. Medicare Part D coverage is offered through private insurance companies through either a stand-alone Part D Prescription Drug Plan or a Medicare Advantage plan with prescription drug coverage.
According to the Department of Health and Human Services, Medicare Part D plans cover all vaccines that are:
- Commercially available
- Reasonable and necessary to prevent illness
- Not covered by Medicare Part B
While Medicare Part B generally covers most vaccines that Medicare patients need, Medicare Part D generally covers vaccines that Medicare Part B does not cover. This would include the shingles vaccine. All Medicare Part D plans are required to cover the shingles vaccine and its administration.
To see if travel vaccines are covered by your Medicare Part D plan, check with the planâs formulary, or list of covered drugs. A new preventative vaccine may not specifically appear in the Medicare Part D plan formulary but the plan may still cover the vaccine.
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Who’s At Risk For Shingles
Anyone who has ever had chickenpox can get shingles, but the risk increases with age. People older than age 60 are up to 10 times more likely to get shingles than younger people. Other factors that increase your risk include:
- Some cancer medicines
- A weak immune system from illnesses such as cancer or HIV
A quarter of adults will develop shingles at some point, and most are otherwise healthy.
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Is A Vaccine Available To Prevent Shingles
Two vaccines are available in the United States to reduce your chance of developing shingles and postherpetic neuralgia. One vaccine, Zostavax®, has been available since 2006. The second vaccine, Shingrix®, has been available since 2017. Shingrix is recommended as the preferred vaccine by the Advisory Committee on Immunization Practices, a group of medical and public health experts.
Shingrix is given as a two-dose shot in your upper arm. You should receive the second dose two to six months after receiving the first. Shingrix has been shown to be more than 90% effective in preventing shingles and postherpetic neuralgia. Its effectiveness remains above 85% for at least four years after receiving the vaccine.
Check If You Have Shingles
The first signs of shingles can be:
- a tingling or painful feeling in an area of skin
- a headache or feeling generally unwell
A rash will appear a few days later.
Usually you get the shingles rash on your chest and tummy, but it can appear anywhere on your body including on your face, eyes and genitals.
The rash appears as blotches on your skin, on 1 side of your body only. A rash on both the left and right of your body is unlikely to be shingles.
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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:
When You Should See Your Doctor
Go to your doctor as soon as you see the rash, as treatment is most effective if its started early.
Your doctor may prescribe antiviral medicine, which may help you recover faster and will reduce the chance that the pain will last for a long time.
Your doctor may also give you medicine for pain relief.
See your doctor again if:
- you get any blisters on your face
- your fever or pain gets worse
- your neck gets stiff, you cant hear properly or you feel less able to think clearly
- you develop new symptoms such as drooping or weakness to one side of your face
- the blisters show signs of infection or if you see milky yellow drainage from the blister sites.
Call Healthline if you are unsure what you should do.
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Do You Always Get The Typical Rash If You Have Shingles
Occasionally, some people dont get a rash. If you have any of the other symptoms of shingles , see your healthcare provider sooner rather than later. There are effective treatments you can take early for shingles. Even if you dont have shingles, seeing your healthcare provider will help you get your condition diagnosed and treated.
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What Does Shingles Feel And Look Like
A viral infection, shingles cause an outbreak of a painful rash that may appear as a band-like rash of fluid-filled blisters along one area of your body. For most patients, the rash is usually on one side of the body, where the nerve is located. Shingles won’t typically spread over your whole body but is localized to that particular nerve distribution.
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Can Shingles Cause Chronic Pain
In some people, the pain of shingles may linger for months or even years after the rash has healed. This pain, due to damaged nerves in and beneath the skin, is known as postherpetic neuralgia. Others feel a chronic itch in the area where the rash once was. In severe cases, the pain or itching may be bad enough to cause insomnia, weight loss, or depression.
Does Medicare Cover The Shingles Vaccine Will I Have To Pay For The Shot
The CDC recommends people 50 years and older get the shingles vaccine. The shot is widely available and the cost may be covered if you have Medicare Advantage or Medicare Part D. Depending on your plan, you may have to cover a deductible, co-pay, or pay for the shot out of pocket and get reimbursement.
Shingles can cause serious complications, like painful long-term nerve damage. To stay safe from such complications, you may want to consider the new shingles vaccine . An older vaccine once widely administered in the U.S. was less effective and is no longer on the market.
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Timeline Of Shingles Symptoms
Shingles actually doesnât occur without a prior chickenpox infection. VZV lies dormant in nerve roots after you recover where it can reactivate years later, returning as shingles. But though they share the same viral cause, the two conditions are distinct.
The first sign of shingles is usually a burning or stinging sensation in a band-like formation around the waist, chest, stomach, or back.
You may experience itching or become incredibly sensitive to even the softest touch. The weight of bed sheets on your skin may be uncomfortable. You may also experience fatigue, fever, and headache.
After a few days or even up to a couple of weeks, the telltale shingles rash will appear. This rash consists of fluid-filled blisters that worsen quickly. The blisters may look like chickenpox, but they are clustered together.
The shingles rash can vary in color, depending on your skin tone. On darker skin, the rash may be pink, grayish, dark brown, or even purple. On lighter skin, it will be red.
This is the stage at which VZV can be passed on to someone who has never had or been vaccinated against chickenpox.
Blisters typically scab over within a week to 10 days. Shingles typically takes three to five weeks to progress through all of its stages.
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How Is Postherpetic Neuralgia Treated
Treatments include lotions or creams and/or other medications not specifically used for pain, such as antidepressants or drugs for epilepsy. Regular pain relievers are not usually effective for this type of pain.
If your pain doesnt lessen, you might try therapies like nerve blocks or steroid injections near the area where the nerves exit the spine. Your provider might suggest an implantable nerve stimulator device for severe, ongoing pain that hasnt responded to other treatments.
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What Are The Health Complications
The most common complication of shingles is postherpetic neuralgia . PHN causes severe pain even after the shingles rash clears.
People aged 60 years and older who dont seek treatment for shingles are more likely to develop PHN.
Shingles can also cause serious sight problems if it infects the structures of the eye.
Other rare complications include:
Where Does Shingles Come From
When you have chickenpox as a child, your body fights off the varicella-zoster virus and the physical signs of chickenpox fade away, but the virus always remains in your body. In adulthood, sometimes the virus becomes active again. This time, the varicella-zoster virus makes its second appearance in the form of shingles.
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Vaccines At Pharmacies Covered
Vaccines will be covered at in-network retail pharmacies. Find an in-network pharmacy at etf.benefits.navitus.com .
Get vaccinated at any in-network pharmacy, using your pharmacy benefit.
- How much does it cost? $0, its free!
- Which vaccines are available? Influenza, Pneumonia, Tetanus, Hepatitis, Shingles, Measles, Mumps, Human Papillomavirus , Pertussis, Varicella, Meningitis
Just show your Navitus card at the pharmacy. If you prefer, you can still get vaccinated at your doctors office using your medical benefit.
If you are considering getting your vaccine/immunization from the pharmacy, here are a few things to keep in mind:
1. Contact the Pharmacy Ahead of Time
Not all pharmacies are able to administer all vaccines/immunizations for various reasons.
2. Make Sure To Use an In-Network Pharmacy
While most pharmacies participate in the Navitus network, and can administer vaccines/immunizations, not all of them do. A claim for a vaccine/immunization will be rejected if you use an out-of-network pharmacy and you will have to pay the full cost. If the pharmacy you prefer to use for your vaccine/immunization is not in the Navitus network , contact your health plan to see if they will cover your claim through the pharmacy under the medical benefit.
To find a in-network pharmacy contact Navitus at 1-866-333-2757 or visit them online at www.navitus.com.
3. Bring Your Navitus ID Card With You
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