Does medicare cover the shingles vaccine?
Furthermore, if you are in a Medicare Advantage Plan without drug coverage, you can switch to a Medicare Advantage Plan with drug coverage. Alternatively, you can drop Medicare Advantage Plan and join a Medicare prescription drug plan (Part D).
Part B covers the following Medicare Vaccines: flu, hepatitis B, and pneumococcal shots. However, Medicare Part B does not cover shingle shots. Likewise, Medicare Part A which covers inpatient hospital care also does not cover shingle shots. To get shingles coverage, you need to have Medicare Part D or Medicare Advantage Plan with drug coverage.
Senior Healthcare Direct can help you find the right Medicare Advantage Plan. You can find a plan that includes your doctors and medication. Otherwise, you can find the right Part D drug plan.
It’s a good thing you can get Medicare coverage for shingles because an estimated 1 million people get shingles each year in the United States. In fact, the Centers of Disease Control and Prevention (CDC) reports about 1 out of 3 people in the United States will develop shingles in their lifetime. Who can get singles?
Who can get Singles?
The shingles virus is called Herpes Zoster. If you have ever had chickenpox, you can get shingles. The risk of shingles increases with age. Therefore, if you are age 65 or older, you have an increased risk of developing shingles. For this reason, many doctors recommend seniors get the shingle vaccine.
Why You Need Shingles Vaccine
Shingles is a viral infection that affects the nerves. The shingles virus also called Herpes Zoster produces a painful rash with blisters as shown in the photo. When you get the shingles vaccination, it helps reduce the risk of having shingles. In addition, the shingles vaccine can lessen the length and severity of illness if you get shingles.
People usually recover from shingles within weeks. However, in rare cases Shingles can have serious complications including death. In other cases, people experience Postherpetic Neuralgia and continue to have pain in the area where the rash had been for months or years after the skin has healed.
Shingles mostly affects older adults who had chickenpox when they were younger. If you are a senior age 65 or older, you have an increase risk of developing Shingles. The painful, blistering rash can cover many areas of your body including: waist, chest, stomach, buttocks, neck, or face.
To prevent shingles, you need to get shingles vaccine shots. You can either get Zostavax shot (zoster vaccine live) or Shingrix shot (zoster vaccine recombinant). Which shigles vaccine is best for seniors?
Best Shingles Vaccine for Seniors
At CDC advisory meeting on June 21, 2017, a study showed Shigrix significantly reduced the risk of developing shingles by 90 to 97% in subjects 50 years and older. By contrast, Zostavax cuts the risk of shingles by only 69.8% in those 50 to 59 years old, and by only 51% for people 60 years and older. Thus, the most effective shingles vaccine for seniors is Shigrix.
How are these shingles vaccines administered?
Shingles Vaccine Injections
The Zostavax vaccine shot is subcutaneous, under your skin, and a one-time injection. The Shingrix shingles shot is intramuscular, in your muscle, and requires 2 injections. The second does is given 2 to 6 months after the first.
Since Shingrix shot is into your muscle you can expect it to be more painful. However, it is more effective at reducing risk of shingles in people age 50 or older. Moreover, doctors recommend Shingrix for immunocompromised people because it is a recombinant, non-live vaccine.
Where and how to get shingles vaccine?
You can get the shingles vaccine at a pharmacy in your network. In other words, you want to make sure you get the Shingles vaccine in a pharmacy that is in your plan’s network. For seniors who want the most effective shingles vaccine, you can find a pharmacy or doctor near you for a Shingrix shot.
If your doctor vaccinates you, make sure the office staff bills your Part D or Medicare Advantage plan. Likewise, have your in-network pharmacy bill your prescription drug plan. Missing this step could result in you paying the entire bill and having to submit a reimbursement request to your plan.
What Does Shingles Vaccine Cost?
Before Medicare Part D or Medicare Advantage plan will pay anything, you may need to pay the annual deductible. Typically, the shingles vaccine is a tier 3 drug with a higher deductible. Deductibles vary between Medicare drug plans. However, the maximum deductible you will pay in 2021 is $445. (Medicare.gov)
Your Shingles Vaccine Cost
Your shingles vaccine costs maybe $150 to $200 before you meet your plan’s deductible. However, after you meet your plan’s deductible, it may be only $20 to $50. Your shingle’s vaccine cost will vary by Medicare plan and the type of shingles vaccine. Get your Shingrix coupon at GoodRx.
Other Medicare Vaccine Coverage
Common Medicare Questions about Shingles Vaccine
Original Medicare does not cover shingles vaccine. However, Medicare Part D and Medicare Advantage plans with drug coverage do cover shingles vaccine.
Seniors or anyone 50 years or older should get the new Shingrix vaccine. This Shingrix vaccine is the best way to protect yourself against shingles according to the CDC. The Shingrix vaccine is covered by Medicare Part D and Medicare Advantage plan with drug coverage.
Shingrix is more than 90% effective at preventing shingles and long-term nerve pain. Shingrix vaccine is covered by Medicare Advantage with drug coverage and Medicare Part D.
About 1 out of 3 people in the United States will develop shingles during their lifetime. It is most common with people 50 years and older. Therefore, seniors are eligible for Medicare Part D and Medicare Advantage plans can get coverage for shingles vaccine.
Anyone who has had chickenpox can get shingles. More than 99% of Americans born before 1980 have had chickenpox, even if they do not remember it.
Your risk of shingles and complications increase as you age. Seniors age 65 and older are eligible for Medicare Part D and Medicare Advantage plans with drug coverage for shingles vaccine.
Shingle vaccines are approved for adults age 50 and older for the prevention of shingles and related complications (Mayoclinic.org).