Who Is In Danger Of Catching 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.
What Shingles Vaccines Are Available
According to the Centers for Disease Control and Prevention , there are 2 vaccines licensed and recommended to prevent shingles in the U.S.: Shingrix and Zostavax.2 The CDC recommends that healthy adults 50 years and older get 2 doses of Shingrix, separated by 2 to 6 months, to prevent shingles and the complications from the disease.3
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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How Much Does The Shingles Shot Cost
There is currently only one shingles vaccine available in the United States, sold under the brand name Shingrix. An older shingles vaccine called Zostavax was taken off the market in November 2020.
Shingrix is delivered in two shots. Without insurance, each shot retails for around $202 for a total of $404, according to GoodRX in 2021. Discounts can lower that cost by nearly $50 per shot.
Medicare Part D and Medicare Advantage plans may cover most of the cost of the Shingrix vaccine, but you could have out-of-pocket costs for both the shot and your doctor visits.
Before getting the vaccine, check with your plans administrator to make sure your policy covers the shingles shot.
Know Your Shingles Risk
You can get shingles at any age if youve had chickenpox.
But older adults and those who are immunocompromised get it most often. Two-thirds of shingles cases in Canada happen to people over 50 years old. The severity of shingles and its complications also increase with age.
Age is the most important risk factor.
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Is Shingrix Covered By My Medicare Health Plan
Yes and no. Medicare Part A and Medicare Part B do not cover the shingles vaccine.
Coverage, however, may be available through your Medicare Advantage or Medicare Part D plan.
Medicare Part D is the portion of Medicare covering prescription drugs and typically also covers commercially available vaccines, at varying amounts.
If you havent met your plans deductible for the year, you may have to pay full price.
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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What Are The Symptoms
Shingles symptoms happen in stages. At first you may have a headache or be sensitive to light. You may also feel like you have the flu but not have a fever.
Later, you may feel itching, tingling, or pain in a certain area. That’s where a band, strip, or small area of rash may occur a few days later. The rash turns into clusters of blisters. The blisters fill with fluid and then crust over. It takes 2 to 4 weeks for the blisters to heal, and they may leave scars. Some people only get a mild rash. And some do not get a rash at all.
It’s possible that you could also feel dizzy or weak. Or you could have pain or a rash on your face, changes in your vision, changes in how well you can think, or a rash that spreads. A rash or blisters on your face, especially near an eye or on the tip of your nose, can be a warning of eye problems.
if you think you may have shingles. It’s best to get early treatment. Medicine can help your symptoms get better sooner. And if you have shingles near your eye or nose, see your doctor right away. Shingles that gets into the eye can cause permanent eye damage.
When Should I See A Doctor Because Of The Side Effects I Experience From Shingrix
In clinical trials, Shingrix was not associated with serious adverse events. In fact, serious side effects from vaccines are extremely rare. For example, for every 1 million doses of a vaccine given, only one or two people may have a severe allergic reaction. Signs of an allergic reaction happen within minutes or hours after vaccination and include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness. If you experience these or any other life-threatening symptoms, see a doctor right away.
Shingrix causes a strong response in your immune system, so it may produce short-term side effects more intense than you are used to from other vaccines. These side effects can be uncomfortable, but they are expected and usually go away on their own in 2 or 3 days.
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Treatment If The Condition Gets Worse
In some cases, shingles causes long-term complications. Treatment depends on the specific complication.
- Postherpetic neuralgia is persistent pain that lasts months or even years after the shingles rash heals. Certain medicines, such as anticonvulsants, antidepressants, and opioids, can relieve pain. Most cases of PHN resolve within a year.
- Disseminated zoster is a blistery rash over a large portion of the body. It may affect the heart, lungs, liver, pancreas, joints, and intestinal tract. Treatment may include both antiviral medicines to prevent the virus from multiplying and antibiotics to stop infection.
- Herpes zoster ophthalmicus is a rash on the forehead, cheek, nose, and around one eye, which could threaten your sight. You should seek prompt treatment from an ophthalmologist for this condition. Treatment may include rest, cool compresses, and antiviral medicines.
- If the shingles virus affects the nerves originating in the brain , serious complications involving the face, eyes, nose, and brain can occur. Treatment depends on the nature and location of the complication.
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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Who Should Not Get Shingrix
You should not get Shingrix if you:
- have ever had a severe allergic reaction to any component of the vaccine or after a dose of Shingrix
- tested negative for immunity to varicella zoster virus. If you test negative, you should get chickenpox vaccine.
- currently have shingles
- currently are pregnant or breastfeeding. Women who are pregnant or breastfeeding should wait to get Shingrix.
If you have a minor acute illness, such as a cold, you may get Shingrix. But if you have a moderate or severe acute illness, you should usually wait until you recover before getting the vaccine. This includes anyone with a temperature of 101.3°F or higher.
The side effects of the Shingrix are temporary, and usually last 2 to 3 days. While you may experience pain for a few days after getting Shingrix, the pain will be less severe than having shingles and the complications from the disease.
Does Medicare Cover The Shingles Vaccine
- The Centers for Disease Control and Prevention recommends healthy adults age 50 and older get the shingles vaccine.
- Original Medicare wont cover the vaccine.
- Medicare Advantage or Medicare Part D plans may cover all or a portion of the shingles vaccine costs.
As you get older, youre more likely to get shingles. Fortunately, there is a vaccine that can prevent the condition.
Medicare Part A and Part B wont cover the shingles vaccine. However, you may be able to get coverage through a Medicare Advantage or Medicare Part D plan.
Keep reading to find out how to get Medicare coverage for the shingles vaccines or get financial help if your plan doesnt cover the vaccine.
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What Matters Most To You
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to get a shingles vaccine
Reasons not to get a vaccine
I want to lower my chances of getting shingles.
I would rather take my chances without getting a vaccine.
I’m afraid of the pain that shingles can cause.
I’m not afraid of shingles pain.
Getting shots doesn’t bother me.
I don’t like getting shots.
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.
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How Much Does The Shingles Vaccine Cost
The amount you pay for the shingles vaccine will depend on how much your Medicare plan covers. Remember that if you only have original Medicare and no prescription drug coverage through Medicare, you may pay full price for the vaccine.
Medicare drug plans group their medications by tier. Where a drug falls on the tier can determine how expensive it is. Most Medicare drug plans cover at least 50 percent of a drugs retail price.
PRice ranges for the shingles vaccine
- Deductible copay: free to $164 for each shot
- After deductible is met: free to $164 for each shot
- Donut hole/coverage gap range: free to $74 for each shot
- After the donut hole: $7 to $8
To find out exactly how much you will pay, review your plans formulary or contact your plan directly.
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.
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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.
Will Medicare Cover My Shingles Vaccine
NEW YORKAugust 20, 2021
Original Medicare, Medicare Part A and Medicare Part B do not cover the shingles vaccine. However, the right Medicare Supplement Plans will cover shingles shots and other vaccines.
Medicare Part D, Medicares prescription drug plan that you can purchase with Medicare or Medicare Advantage, covers the vaccine, but otherwise you will likely have to pay out of pocket. If you havent hit your plans deductible for the year, you will pay the full price for the vaccine.
What is shingles?
Shingles is a viral infection caused by the varicella-zoster virus, which also causes chickenpox. If youve had chickenpox before, the virus can remain dormant in your nerve tissue near the brain or spinal cord. After many years, the virus may reactivate as shingles, which causes a rash that can be very painful, but it is not life-threatening. However, shingles can lead to complications.
Shingles usually appear in small areas of the body as red rashes that can itch, tingle, or burn. You might also find blisters, or the area is very sensitive to the touch. Some people also experience fever, headaches, sensitivity to light, and fatigue.
Sometimes shingles can be mistaken for heart, kidney, or liver problems if the pain manifests near those organs.
Are shingles contagious?
Should I get a shingles vaccine?
Where can I get a shingles vaccine?
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Does Medicaid Cover Vaccines For Adults
In addition to the COVID-19 vaccine, the CDC recommends 13 vaccines for adults:
Tetanus, diphtheria, pertussis
Measles, mumps, rubella
Meningococcal A, C, W, Y
Haemophilus influenzae type B
Under Medicaid, coverage for these vaccines, and others, depends on the policies of the state you live in. A recent study found that 22 out of 51 state Medicaid programs covered all 13 recommended vaccines.
For those who live outside of those states, there may be free and low-cost vaccine options that can help. Or, if you have coverage but the cost is still too high, a coupon, like those available from GoodRx, may help you save money.
Personal Stories About Considering A Shingles Vaccine
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I talked to my doctor about the shingles vaccine and I think I’m going to get it. My wife had shingles 2 years ago, and she was really in a lot of pain. If I can avoid that by getting a vaccine, it will really be worth it to me.
I’m not going to get a vaccine, at least not right now. I don’t like to take medicines of any kind if I don’t have to.
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