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
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.
What Are My Options For The Shingles Shot And How Does It Work
As of November, 2020, there is only one shingles vaccine available in the United States. This goes by the trade name Shingrix.
Shingrix was approved by the FDA in . It is more than 90 percent effective at preventing shingles and postherpetic neuralgia after two doses of the vaccine.
An earlier vaccine, Zostavax, is no longer in use in the United States as of November 18, 2020. Zostavax first got FDA approval in 2006. It was about 51 percent effective at preventing shingles and 67 percent effective at preventing PHN.
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Will Medicare Cover The Shingles Shot
March 17, 2020 by bob
I get a lot of questions from clients about the Shingles Vaccine and will their Medicare plan cover the cost of the shot. The answer is yes, but it does depend on the Part D drug plan you have and the pharmacy you use.
Medicare Part A or Medicare Part B doesnt cover the shingles shot. Generally, Medicare prescription drug plans cover all commercially available vaccines needed to prevent illness. So Medicare part A and B do not cover the shots but your Medicare part D drug plan will cover it at a preferred pharmacy.
Medicare coverage for Shingrix and Zostavax, the two commercially available shingles vaccines, is provided only if you are enrolled in a stand-alone Part D drug plan or a Medicare Advantage plan that includes Part D drug coverage. There are many Medicare part D plans available so the plan you have will have a list of preferred pharmacies for you to choose, I would suggest doing a little research on which pharmacy provides and administers the shot and what co-pay tier level the vaccine is considered. If you would like us to assist you in that research please contact us, we are happy to assist.
Medicare Part D Plan AVERAGE CO-PAY
AARP MedicareRx Preferred $72
AARP MedicareRx Saver Plus $51
AARP MedicareRx Walgreens $49
Aetna Medicare Rx Saver $30
Express Scripts Medicare Value $63
Humana Enhanced $150
Humana Walmart Rx Plan $53
SilverScript Plus $63
Facts about the Shingles Vaccine
Who Should Get Shingrix
Counseling Patients About Shingrix
Know the benefits and side effects of Shingrix so youre prepared to talk with your patients before administering the vaccine.
What to tell patients about Shingrix benefits:
- You can protect yourself against shingles. Shingles is a very painful disease, and your risk of getting it increases as you age. Also, you are more likely to have severe, long-term pain if you get shingles when you are older. About 1 out of every 3 people in the United States will develop shingles in their lifetime.
- Shingrix provides strong protection against shingles and long-term pain from the disease. Two doses of Shingrix are more than 90% effective at preventing shingles. So its very important that you get this vaccine.
What to tell patients about Shingrix side effects:
What to tell patients about dose two:
- You need to come back in 2 to 6 months for your second dose. We can make that appointment now.
- Even if you have side effects from the first dose, it is important to get the second dose to build strong protection against shingles. Your reaction to each dose may be different just because you have a reaction to the first dose does not mean that you will have a reaction to the second.
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Unicare State Indemnity Plan / Medicare Extension Ome With Cic
About the Product:
- Use any doctor and any hospital in the U.S. This means you can get routine and ongoing care when youre away from home. Youll get the highest benefit when you use Medicare participating providers.
- Coverage for care when you travel outside of the U.S.
- Your Medicare coinsurance and deductible are covered.
- Your prescriptions are covered. Theres no coverage gap no doughnut hole to leave you stuck with costly prescription drug bills.
- Your doctor visits are covered for a $10 copay. You have the same copay when you see nurse practitioners and physician assistants or use urgent care centers or retail medical clinics.
- Routine eye exams are covered every two years for a $10 copay.
How Much Will You Pay For Shingles Vaccines
You can find the shingles vaccine 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.
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What States Offer Silverscript Part D Plans
SilverScript offers three different Part D plans:
- SilverScript SmartRx
- SilverScript Choice
- SilverScript Plus
SilverScript Choice and SilverScript SmartRx plans are available to residents of all 50 states. SilverScript Plus is available to residents of every state except Alaska.
SilverScript offers prescription drug coverage through three different Medicare Part D plans. Heres an overview of each option well dive deeper into price details later in the article.
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.
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Silverscript Mail Order Services
Many times, people may like to use mail order pharmacy services. Mail order can be beneficial for those who arent able to leave their house. You can choose to have your medication sent to your home or place of employment. Both Choice and Plus members can use this service.
Another remarkable benefit is the ability to receive 90-day supplies at one time. Talk about convenient!
How To Get Part D Coverage
You can get Medicare Part D coverage either through a stand-alone Part D Medicare Prescription Drug Plan or through a Medicare Advantage plan that includes prescription drug coverage. Both stand-alone Medicare Part D Prescription Drug Plans and Medicare Advantage plans are available from private, Medicare-approved insurance companies. With a stand-alone Medicare Part D Prescription Drug Plan, you will keep your Original Medicare coverage. A Medicare Advantage plan is another way to get you Part A and Part B benefits although you must continue to pay your Part B premium as well as any premium the plan may charge. Hospice benefits are still covered directly under Medicare Part A.
Would you like to know more about Medicare coverage of vaccines? Id be happy to help you. I can walk you through your options or email you information you can request that using the links below. Or take a look at plans by clicking the Compare Plans buttons on this page.
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How Much Does Shingrix Cost With Insurance
Many insurance plans cover Shingrix, but your copay will depend on your insurance plan. Visit your local pharmacy to calculate your copay with insurance with help from a pharmacist. Keep in mind that you could pay our lowest price of $183.33 with SingleCare. Just use the Shingrix coupon provided by SingleCare above. SingleCare prices may be even cheaper than your insurance.
Are Any Other Vaccines For Older Adults Available At Local Pharmacies
In addition to the flu vaccine, some pharmacies are able to provide other vaccinations recommended for older adults.
Pneumococcal vaccine: Protects against pneumonia and other types of infections caused by the most common strains of a bacterium called Streptococcus pneumoniae. The pneumococcal vaccine is recommended for all adults over 65 years old, and for adults younger than 65 years who have certain chronic health conditions.
Tdap or Td vaccine: Protects against tetanus, diphtheria, and pertussis . Every adult should get the Tdap vaccine once if they did not receive it as an adolescent to protect against pertussis, and then a Td booster shot every 10 years. In addition, women should get the Tdap vaccine each time they are pregnant, preferably at 27 through 36 weeks of pregnancy.
Shingles vaccine: Protects against shingles and a painful complication of shingles called post-herpetic neuralgia . The shingles vaccine is recommended for all adults 50 years of age and older. There are two shingles vaccines available: Shingrix and Zostavax. The Centers for Disease Control and Prevention recommends that healthy adults ages 50 years and older receive two doses of Shingrix, which is the preferred vaccine. Zostavax requires only one dose and may be used in healthy adults ages 60 and older.
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How Much Does Shingrix Cost Without Insurance
The price of Shingrix without insurance is around $241.70 for 1, 50MCG/0.5ML Suspension Reconstituted. However, you can save significantly on the price of your prescription drug when you use SingleCare. Shingrix coupons from SingleCare will reduce your total to $183.33 for Shingrix even without insurance. Ask your local pharmacist to run your discount card to compare Shingrix prices before you overpay for another prescription.
About The Shingles Vaccine
The Centers for Disease Control and Prevention recommends that healthy adults over the age of 50 get the shingles vaccine because it’s the only way to protect against the disease and its associated side effects. The risk of getting shingles increases as you age or if you have a weakened immune system. Always consult your doctor to find out if the shingles vaccine is right for you.
The CDC recommended vaccine, Shingrix, is a recombinant zoster vaccine that has two doses administered within six months of each other. It’s classified as a Tier 3 drug by most insurance companies, which means it’s a brand-name pharmaceutical with a higher copayment than a Tier 1 or 2 drug.
Use the Shingrix vaccine locator to find where the shingles vaccine is being offered, and check with your Medicare Part D or Medicare Advantage provider to see which locations give you the lowest price.
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Some Vaccines Covered Better Than Others
Unlike the flu and pneumonia vaccines, which are fully covered as preventive services under Medicare Part B, the shingles shot and other recommended vaccinations are covered as prescription drugs under Medicare Part D and Medicare Advantage plans.
Some of those plans provide better coverage than others, but nearly all of them divide their formularies, or list of covered drugs, into tiers according to cost. Drugs in Tier 1 and 2, mainly lower-priced generics and preferred brand-name drugs, have lower co-pays than more expensive nonpreferred brands in Tier 3 or 4.
Consumer Reports found that many Part D plans categorize the shingles vaccine, Zostavax, as an expensive Tier 3 or 4 drug. Only one pharmaceutical companyMerckmakes the shingles shot, and theres currently no generic version.
That means if you havent met your annual deductible, youll likely wind up paying full price for the shot, which is about $217. But depending on your plan, even after the deductible is met, consumers may have to pay a significant part of the shingles vaccine costup to $100.
Many healthcare providers havent set up billing systems to file claims through prescription drug plans. So if you’re vaccinated at your doctors office, you might be required to pay the full shingles vaccine cost up front and then file to be reimbursed by your insurance.
How Can You Save On The Cost Of The Shingles Vaccine
These five tips can help you to pay less for a shingles vaccine.
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Aetna Medicare Premium Assistance
Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The SilverScript SmartRx medicare insurance plan offers a $3.10 premium obligation if you receive a full low-income subsidy assistance. And the payment is $4.10 for 75% low income subsidy $5.20 for 50% and $6.20 for 25%.
|$0 Premium with Full LIS:||No|
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.
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I Have Insurance Through My Employer Or A Private Policy
If you have prescription drug coverage through work or a private policy, your insurance provider will set a fixed co-pay or co-insurance percentage for you to pay for your prescriptions.
To help ensure the price of your medicine is affordable to you, BENLYSTA offers a co-pay program that helps eligible patients. It helps with up to a total of $15,000 for 12 months. Eligible patients could pay as little as $0 for BENLYSTA. .
There are 2 ways to get started with the BENLYSTA Co-Pay Program:
*Medicare-eligible patients and patients enrolled in government-funded programs are not eligible for the BENLYSTA Co-pay Program.