You Can Get A Shingles Vaccine Two Ways:
At the pharmacy. Youll still need a doctors prescription, but once thats been transmitted, you can get the shot at a retail pharmacy.
Most major chains and some independent pharmacies can administer the vaccine. Just make sure to use a store in your drug plans network so that it can bill your plan directly and youll owe just the copayment.
At the doctors office. If youre vaccinated in a doctors office, check whether it can bill your drug plan directly or works with a pharmacy that can do so. If so, it will work as mentioned above, with you owing a copayment. If not, you may need to pay the full cost up front and then file a claim for reimbursement from your plan.
Remember that the doctors fee for administering the vaccine may exceed your plans allowable charge, in which you case youre on the hook for the difference. It pays to check beforehand.
Editor’s note: This article was originally published on Jan. 1, 2014. It has been updated with the latest information regarding Medicare coverage in 2020.
Does Medicare Advantage Cover A Shingles Vaccine
If you have a Medicare Advantage plan with prescription coverage, then the shingles vaccine will be covered. If you dont have prescription coverage, youll have to pay for the vaccine yourself.
As with traditional Medicare, the cost of the vaccine can vary by plan. Youll save money by getting your vaccine from a pharmacy in your plans network.
How To Get A Shingles Vaccine Covered By Medicare
Once you have an insurance plan that covers shingles vaccines, purchasing them is the next step. Many 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 first for the vaccine.
Remember, only a pharmacy can bill Medicare Part D for your vaccine and provide you the best coverage, so in order to get the best price, you will want to get your vaccine in a pharmacy. If your pharmacy of choice does not have standing orders for the shingles vaccine, then you will want to visit your physician first to acquire a prescription.
Its possible to save money on shingles vaccines with a SingleCare pharmacy savings card. SingleCare can help uninsured or underinsured patients get shingles vaccines at a discounted price.
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How Does Medicare Cover The Shingles Vaccine
Original Medicare, Part A and Part B, does not cover the shingles vaccination but Medicare Part D does. To get this covered, you must enroll in either a stand-alone Medicare prescription drug plan or a Medicare Advantage plan that includes prescription drug coverage . You may have a copayment for the shingles vaccine.
Shingles Vaccine Cost And Options
Shingles, or herpes zoster, is caused by the varicella-zoster virus. This is the same virus that causes chickenpox, the childhood disease. It remains in the person’s body after chickenpox passes and can reactivate later in life.
Once the virus reactivates, it travels to the skin where it causes blisters. Old age, poor immune function, and having chickenpox are risk factors for the reactivation of the virus.
The rash is the characteristic finding of shingles. It can appear on one side of the face or body. The rash contains blisters that will clear up in 2 to 4 weeks.
Before the rash develops, pain, itching, and tingling may affect the area where the rash will appear. These warning signs will appear a few days before the rash.
Other symptoms include fever, fatigue, and headache. Chills and an upset stomach are also common.
This disease can lead to serious complications. It can lead to eye problems such as blindness. Other complications include encephalitis, pneumonia, and skin infections.
In some cases, people can experience severe nerve pain after the rash has cleared. This type of pain can last months and even years after the rash passes. About 1 in 5 people may develop this symptom.
To reduce the risk of getting shingles, those at risk should get vaccinated. Shingrix and Zostovax are the two shingles vaccines available. Getting the shingles vaccine is a must as it’s the only way to protect against shingles.
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What Is The Shingles
The shingles is related to the chicken pox but they are not the same disease. With the Shingles youll develop a very painful itchy rash that can last up to five weeks! Its estimated that around 1 million Americans suffer from the shingles every year. Risk and severity increase with age. It can even result in possible nerve damage. This is why the CDC recommends all adults over 50 get vaccinated.
Medicare Part B Coverage For Shingles Treatment
Shingles appear as a painful rash on one side of your body. You may feel pain, itching, or tingling before the rash develops, and you may also have a fever, headache, or upset stomach. The rash turns into blisters that usually scab up within a week to 10 days.
If you believe you have shingles, its best to see a doctor right away. Prescription antiviral medications can shorten the illness and make it less severe, but they work best if you start taking them as soon as possible after the rash appears. If your pain is severe, your doctor may also prescribe pain medication or give you a corticosteroid injection.
Part B covers a visit to a doctor or urgent care center. It also covers any injections you receive at the doctors office. If you have a Medicare Supplement plan, you may not have to pay anything out of pocket to see a doctor for shingles.
If you have a Medicare Advantage plan, Part B will still cover doctor visits and injections. But youll have different costs than if you had Medicare.
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What Is The Price Of The Shingles Vaccine
The average retail price for a single dose of Shingrix, the CDC-recommended shingles vaccine, is around $200. The regular copay for those who have met their deductible but havent passed the Initial Coverage Level would range from $0 to $164 . You will be able to cover the expense of the shingles vaccine with GoodRx or other related companies sale coupons.
Does Medicare Pay For Shingles Shots
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, orlearn more about Part D first.
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How To Get Medicare Shingles Vaccine Coverage
Although Original Medicare does not cover the shingles vaccine, these two solutions will enable you to get Shingrix coverage.
Sign up for a Medicare Advantage Plan which includes Medicare Part D
Another choice is to join a Medicare Advantage Plan, also known as Medicare Part C. They are incredibly well-known. According to the Kaiser Family Foundation, 36% of Medicare recipientsor about 24.1 million individualsare participating in Medicare Advantage plans. Private health providers sell Medicare Advantage options, which include Part A and Part B. Most contracts also provide prescription insurance as well as other services. Medicare Part C plans can also provide products and facilities not covered by Original Medicare, such as dental insurance, hearing aids, and glasses.
Only if you have a Medicare Advantage plan that has prescription drug benefits, can the Medicare Advantage plan include the Shingrix vaccine. Medicare Advantage options can be very competitive in terms of coverage. The average monthly premium is about $25, but certain policies have no rates at all. The regular monthly premium for Medicare Part B enrollees in 2021 is $148.50, according to the Centers for Medicare and Medicaid Services .
How Do You Get Shingles
Shingles is a disease that can affect anyone who has had chickenpox. There’s no way of knowing who will get shingles. There are risk factors that can give people an idea if they are at risk for developing shingles.
Advanced age is a major risk for this disease. The risk of getting it increases with age. Around half of the cases of shingles are diagnosed in adults 60 and older.
Persons who are older than 70 have the highest risk of getting shingles. Persons who have trouble fighting infections are also at risk. An HIV infection can also put a person at risk for shingles.
A person that has cancer of the bone marrow or lymphatic system shouldn’t get this vaccine. People undergoing radiation or chemotherapy need to refrain too.
You should know that shingles is not contagious. It can’t be transmitted from one person to another. Still, precautions need to be taken.
People who have never had chickenpox can get chickenpox from a person who has shingles. If you haven’t had chickenpox or aren’t sure if you had it, make sure to stay away from anyone who has shingles.
If you have shingles, you need to stay away from others. Avoid being around people with a weak immune system. People who have a poor immune system are highly susceptible to this disease.
There are several things that people with shingles can do to help reduce another person’s risk of getting chickenpox. Cover the shingles rash as direct contact with the fluid from the rash blisters can cause chickenpox.
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Medicare May Not Provide Good Coverage For This Vital Protection
If you’re covered by Medicare, you may feel the pain of a shingles shot more in your wallet than in your arm.
That’s because the federal program that insures most seniors in the U.S. provides poor coverage for some recommended vaccines, including shingles, and could leave some people paying $200 or more for protection.
Shingles is a viral infection that often causes a painful, blistering rash and, in some cases, leads to lingering nerve pain and, in rare cases, even blindness.
The vaccine isn’t foolproof, but for people aged 60 and older it reduces the risk of getting shingles by about 51 percent and, if you do get shingles, reduces the nerve pain it causes by close to 70 percent, according to the Centers for Disease Control and Prevention.
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.
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.
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Does Medicare Cover Shingles Vaccines
Most health insurance companies cover shingles vaccines, but standalone Medicare coverage wont cover the vaccines. You must be enrolled in a Medicare Part D drug plan in order to have prescription drug coverage that covers shingles vaccines. A Medicare Part A plan or Medicare Part B plan, components of original Medicare, wont give you the right amount of coverage.
You can enroll in a Medicare Part D prescription drug plan by itself, or enroll in a Medicare Advantage Plan that includes Part D coverage. Either of these options will cover Shingrix and Zostavax, the two shingles vaccines on the market.
Every Medicare Part D plan is different and will provide varying degrees of coverage for shingles vaccines. Some plans may have better coverage with lower copayments, and some may have worse coverage with higher copays. Its also possible that you may have a deductible, copay, or coinsurance.
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 which insurance plan is best for you is to talk with a Medicare services advisor.
Medicare.gov is also a helpful resource for comparing Medicare prescription drug plans, searching for providers and facilities, and for estimating potential costs. TTY users can call 877-486-2048 to talk to a Medicare representative.
Vaccines Covered By Medicare Part D
Medicare Part D covers all commercially available vaccines needed to prevent illness. You can get Part D coverage through a stand-alone Medicare prescription drug plan or a Medicare Advantage plan that includes drug coverage.
Vaccines covered by Part D include the following:
- Shingles vaccine: One-time vaccine given in two shots over two to six months
- Tdap vaccine : One shot if youve never been vaccinated, and a booster every ten years
- Other vaccines covered: Vaccines that are “reasonable and necessary” to prevent illness and are not covered by Part B
Part D may also cover vaccines you may need if you are traveling internationally. Talk with your doctor about your travel plans and ask what vaccines are recommended.
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What Are My Options For The Shingles Shot
The two options for the shingles shot are Zostavax and Shingrix. Zostavax, according to the Mayo Clinic, protects against shingles for about five years. Its a live vaccine given as a single shot in the upper arm. The Zostavax shingles shot is recommended to adults age 60 and over which reduces the risk of developing shingles by 51%, according to the Centers for Disease Control and Prevention .
Studies suggest that Shingrix offers protection against shingles for more than five years. Its a nonliving vaccine given in two doses. The Shringrix shingles shot is recommended for adults age 50 and older.
The Shingrix shingles vaccine is more effective than Zostavax. Shingrix is more than 97% effective in preventing shingles in adults 50 to 69 years old after two doses. The Shingrix shingles vaccine is 91% effective in preventing shingles in adults age 70 and older, according to the CDC.
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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More From This Series Insuring Your Health
If the vaccine co-payment is still too high, it may be worth looking into other Part D plans or signing up for one during the upcoming annual enrollment period, Oct. 15 to Dec. 7. Depending on your other prescription drug needs and coverage, you may be able to find a better deal, Lipschutz says.
Its worth noting that under the 2010 health care law, people who have new private health insurance plans and those whose plan benefits have changed significantly are eligible to receive, free of charge, vaccines recommended by the CDCs Advisory Committee on Immunization Practices. Plan members who are in their early 60s, therefore, might qualify for a shingles vaccine without a co-pay.
Q. Do I have to keep my 18-year-old child on my health insurance?
A. In a word, no. The Affordable Care Act requires insurers to offer to cover adult children of policyholders until age 26, but it doesnt require parents to purchase that coverage, according to an official at the Department of Health and Human Services.
Q. Whats to stop a teenager from getting her own individual policy once she finds out shes pregnant, if her parents plan wont cover her maternity care?
A. Although health plans must offer to cover adult children on their parents plans until they reach age 26, insurers arent required to provide them maternity benefits . In that case, a young person or her parents might consider buying an individual policy, as this questioner suggests. But they may run into obstacles.
Shingles Vaccinations Not Covered For Some Medicare Beneficiaries
By Michelle AndrewsSeptember 10, 2012
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