Where To Find Vaccines
Before getting a vaccine, check your Evidence of Coverage or benefit plan document to see if it’s covered by your Humana plan and where you can go to receive the vaccine.
To do this, sign in to your MyHumana account, select Coverage from the main menu and find the Documents and Forms page. Here, you can view all your plan information. You can also speak with Humana member services by calling the number on the back of your member ID card.
We recommend going to your local pharmacy first to see if you can get your vaccines. It may be faster and easier than making an appointment with your healthcare provider, plus it may be covered by your Humana plan.
If you live near a Humana Pharmacy® retail location, you may be able to get the vaccine you need there for little or no charge. Find a location near you. However, if youre unable to visit a Humana Pharmacy location or your local pharmacy, speak with your healthcare provider about how you can get your vaccines.
How Can You Save On The Cost Of The Shingles Vaccine
These five tips can help you to pay less for a shingles vaccine.
Does Medicare Cover Shingrix Or Zostavax
Many Medicare Part D and Medicare Advantage plans provide coverage for Shingrix and/or Zostavax.
- Medicare Part D plans provide coverage exclusively for prescription drugs.
- Medicare Advantage plans provide coverage for all Medicare Part A and Part B benefits, and most Medicare Advantage plans also cover prescription drugs. Some plans also offer dental, vision and hearing benefits, along with a range of other benefits that Original Medicare doesn’t cover.
Both Medicare Advantage plans and Part D plans are sold by private insurance companies.
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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.
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Recommended Vaccines For Adults
The vaccines in the table below are recommended for all adults age 19 and older by the CDC.2 Please note: Your age, job, health and lifestyle may impact the type of vaccines you need.
Consider talking to your healthcare provider about additional vaccines you may need as an adult, such as the Human papillomaviruses* , chicken pox, hepatitis A and B, measles mumps rubella and pneumococcal vaccines.
*The HPV vaccine is recommended for young adults ages 11-26.
Enroll In A Medicare Advantage Plan
Another option is to enroll in a Medicare Advantage plan, sometimes referred to as Medicare Part C. Theyre very popular. The Kaiser Family Foundation reported that 36 percent of Medicare beneficiaries approximately 24.1 million people are enrolled in Medicare Advantage plans.
Medicare Advantage plans are offered by private insurance companies and bundle your Part A and Part B benefits together. Most plans also offer prescription drug coverage and other services as well. Medicare Part C plans often cover items and services that Original Medicare doesnt, such as dental care, hearing aids, and glasses.
Your Medicare Advantage plan will cover the Shingrix vaccine only if you select a plan that offers prescription drug coverage.
In terms of cost, Medicare Advantage plans can be quite affordable. The average monthly premium is just $25, but many plans have $0 premiums. That cost is on top of your Medicare Part B premium. According to the Centers for Medicare & Medicaid Services, the standard monthly premium for Medicare Part B enrollees is $144.60 for 2020.
You can use the Medicare Plan Finder to view available plans, compare coverage options, and see plan pricing so you can enroll in the right Medicare plan for you.
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Why Do You Need The Shingles Vaccine
In a word: pain. Shingles commonly appears as a rash, usually across one side of your chest, abdomen or face. What starts as itching or tingling becomes an extremely painful band of blisters. These usually scab over in seven to 10 days and clear up in two to four weeks.4
Shingles is most common among people over the age of 50, so the Centers for Disease Controls recommends the vaccine for anyone over that age.
People with a weak immune system are at even higher risk. Your immunity may be weakened if you:5
- Are under extreme stress.
Shingles must be active, meaning in the blister phase, to be contagious. You cannot transmit the virus before the blisters appear, nor once they crust over.6 Even if the virus is active, the risk of spreading VZV is low if you keep the shingles rash covered.7
How Much Will You Pay For Shingles Vaccines
You can find both shingles vaccines on your Part D plan formulary or listing of covered medications. Check to see into which tier the vaccine falls the tier will define how much your insurer will pay and how much you will have to pay.14
If your doctors office will provide the vaccination, check to be sure they can bill your plan directly. That way, youll have only the copay. Otherwise, you may have to make the full payment upfront and file with your plan for reimbursement. Also, check to be sure that the doctors fee for administering the shot is covered as part of your plans allowable charge.13
Youll probably pay the least amount out-of-pocket by being vaccinated at a pharmacy thats within your drug plans network. But if you havent met your deductible for the year on your drug plan, you may pay full price for the vaccine.
If you havent had your shingles vaccine yet and youre selecting a Medicare Advantage plan during the Open Enrollment Period, be sure its one of the medications on whatever plan you choose.
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Don’t Overpay: Advice For Medicare Patients
Three out of four Americans eligible for the shingles vaccination still havent gotten it, according to the CDC. Not surprisingly, a 2015 report from the National Vaccine Program found that one of the main reasons adults skip recommended vaccines is the cost.
If youve been putting off getting your shingles shot because you were quoted a high price, check your Part D plan. You may be able to get it for less.
Confusion about insurance coverage for the vaccine can sometimes result in patients paying more than they should, Avitzur says.
Dont delay, as the consequences of shingles can be devastating, advises Avitzur, a neurologist who has seen firsthand the painful effects of lingering nerve damage.
Your best bet may be to get the shot at a pharmacy in your drug plans network. Youll still need to get a prescription from your doctor, but the pharmacy will bill your insurance company and youll pay the lowest out-of-pocket costs available under your plan.
If you would like to get vaccinated at your doctors office, ask up front about the cost. Does your doctor charge more to administer the shot than your plan allows? If so, youll be on the hook for the difference. Also see whether the office will bill your Part D or Medicare Advantage plan directly or work with a pharmacy in your network to handle the billing.
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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Coverage For The Shingles Vaccine
by Patricia Barry, AARP Bulletin
Q. Does Medicare cover the shingles vaccine?
A. Yes, but not in the way you might expect.
Other common vaccines are covered under Medicare Part B. In other words, you get them in a doctors office, then the doctor bills Medicare andin the case of flu and pneumonia shotsMedicare picks up the full tab.
But the shingles vaccine is covered under the Part D prescription drug program. That means you must be enrolled in a private Part D plan , get the vaccine through your plan and pay whatever share of the cost that your plan requires.
You shouldnt have any problem obtaining the shingles vaccine through your drug plan. Under Medicare regulations, all Part D plans must cover it.
But there are some pitfalls to watch out for in terms of paying for the shingles shot, depending on where you receive it:
* If youre vaccinated at a pharmacy, make sure its one that is in your Part D plans pharmacy network. Otherwise, the shot will cost you more than the plans normal copayment, perhaps even full price.
* If youre vaccinated in a doctors office, make sure the doctor can bill your plan directly through its computer billing process, or can work through a pharmacy in your plans network that can also bill the plan directly. Otherwise, youll have to pay the entire bill upfront and then claim reimbursement from your plan.
Patricia Barry is a senior editor at the AARP Bulletin.
Who Should Not Get The Shingles Vaccine
The vaccine may not be appropriate for people who have a weakened immune system due to certain conditions. These people include those with an organ transplant and those who are undergoing chemotherapy to treat cancer.
Doctors also recommend that people with an allergy to any component of the vaccine do not have the shingles vaccination.
Anyone with severe allergies must tell a doctor about them when discussing their shingles risk. People who are pregnant or breastfeeding or currently have shingles symptoms should not get the shot.
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How Much Does The Shingles Vaccine Cost
Depending on your payment source, your cost and coverage for the shingles vaccine can vary. There are costs associated with the vaccine and its administration. Vaccines can be given at a pharmacy, doctors office, or clinic.
If you use your insurance coverage, the least expensive option is typically an in-network pharmacy. If you have an annual deductible for your prescription drug coverage, consider getting both doses of the vaccine within the same calendar year.
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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Other Types Of Plans Do Better
Other forms of insurance do a far better job covering immunizations.
Under provisions of the Affordable Care Act, private planssuch as insurance through your employer or purchased on a state marketplaceare still required to cover recommended vaccinations as preventive medical care, not drugs.
That means that as long as you go to a provider in your plans network, your insurance will pay for preventive care without a co-pay, even if you havent met your deductible.
Its really a shame that older Americans, who are most at risk of contracting shingles and most vulnerable to the potentially serious effects of the disease, often have to pay more than others for the vaccine, says Consumer Reports medical director, Orly Avitzur, M.D.
If youre currently covered by a private health plan but anticipate going on Medicare in the next five years or so, one cost-saving strategy is to talk to your doctor about updating all your vaccinations now while your insurance provides good coverage, Avitzur says. The shingles shot is recommended for nearly all adults aged 60 and older.
How Do I Get Part D
Medicare Part D is a great way to get coverage, not only for the shingles vaccine but for prescription drugs as well. There are two ways to add Part D prescription drug coverage to your Medicare health insurance:
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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.
Getting The Shingles Vaccine
The Shingrix vaccine is produced by GlaxoSmithKline and approved by the Food and Drug Administration for the prevention of shingles in adults 50 and older. The vaccine is administered in two doses, with the second shot given two to six months after you receive the first shot.
The shot works by boosting your bodys defenses against shingles. In clinical trials, Shingrix was 90 percent effective in preventing shingles.
You can get the Shingrix vaccine at the doctors office or a retail pharmacy with a prescription. Its administered as an injection in the upper arm. After the shot, you may experience pain, redness, or swelling at the injection site as well as muscle pain, tiredness, or headaches.
You must get the second dose two to six months after the first shot. You can sign up for second-dose reminders through the Shingrix website to help keep you on track.
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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, 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.
Who Should Get Shingrix
Give Shingrix to immunocompetent adults 50 years and older, including those who
- had shingles in the past
- received Zostavax® at least 8 weeks prior
- have health conditions, such as chronic renal failure, diabetes mellitus, rheumatoid arthritis, or chronic pulmonary disease
- are receiving other vaccines, such as influenza and pneumococcal vaccines, at the same visit
- are taking low-dose immunosuppressive therapy
While Shingrix is not contraindicated in immunocompromised people, the Advisory Committee on Immunization Practices at this time does not recommend it for this population. ACIP will review evidence for Shingrix in immunocompromised people as it becomes available.
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