The shingles vaccine is one that a lot of people are talking about lately. Wondering if Medicare will cover the cost of the shingles vaccine? In this blog post, we will answer your questions. As well as tell you everything you need to know about getting the vaccine. Keep reading to learn more!
Shingles?
Shingles is a painful rash that typically develops on one side of either your face or torso. The same virus the causes chickenpox is responsible for shingles. This will lay dormant in your body. Until it is triggered by stress or a weakened immune system
Shingrix is the only shingles vaccine approved for use in the United States. The vaccine is covered by Medicare prescription drug plans, either a stand-alone plan or as part of a Medicare Advantage Plan.
This blog contains information for your consideration before you get the shingles vaccine. As with any decision you make about your health care, it’s a good idea to weigh the risks vs. benefits and confer with a trusted health care professional.
Who Needs a Shingle Vaccine?
According to the Centers for Disease Control and Prevention (CDC), the Advisory Committee on Immunization Practices (ACIP) recommends the shingles vaccine for people aged 50 and older. It is a manufactured inactivated vaccine intended to prevent shingles. The vaccine is administered in two separate doses given by intramuscular injection, separated by two to six months.
The shingles vaccine is considered an important vaccine for seniors because our immune system weakens as we age. The recommendation for vaccination is based on the potential severity of symptoms and long-term complications.
A shingles vaccine called Zostavax is no longer used in the U.S. as of November 2020. If you received that vaccine, the CDC recommends talking with your doctor about getting the Shingrix vaccine.
What Does Medicare Cover With Shingles?
Original Medicare (Part A and Part B) will cover the shingles vaccine as long as it’s medically necessary and recommended by a doctor. Medicare Part D the Shingrix vaccine.
You may have to pay a copayment or coinsurance for the vaccinations if you have a Medicare Advantage Plan (Part C). You will also need to use a network pharmacy for the Part D coverage to apply.
What If I Have a Supplemental Insurance Plan?
If you have a Medicare Supplement Insurance plan, Original Medicare will cover the shingles vaccine and you may not have any out-of-pocket costs.
Shingles can be a very painful and debilitating condition, so it’s important to do everything you can to prevent it. For more information on Medicare and other insurance-related topics, be sure to check out the rest of our blog!
Will My Medicare Advantage Plan Help?
If you have a Medicare Advantage Plan, it may help you cover the costs of the shingles vaccine. Each plan is different, so it’s important to check with your plan provider to see what coverage is available.
What Costs Can I Expect?
Medicare part D covers the vaccine. You may have to pay a copayment or coinsurance for the vaccinations if you have a Medicare Advantage Plan (Part C).
You will also need to use a network pharmacy for the Part D coverage to apply.
Can You Get the Vaccine For Free?
GlaxoSmithKline is the maker of the vaccine. GSK has a patient assistance program that may provide the vaccine to you at no cost if you meet these eligibility criteria:
- You don’t have prescription drug coverage or a Part D plan and have spent at least $600 during the calendar year
- You are an adult, age 19 or older
- You live in the U.S., Puerto Rico, or the District of Columbia
- You don’t qualify for Puerto Rico’s 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
If you have any questions on where to get the vaccine or who has the best coverage. Please give us a call.