If you can remember how painful getting the chickenpox was as a child, then you have just an inkling of how shingles feels. This is why so many people want to know if Medicare covers the shingles vaccine.
Yes, Medicare does cover the shingles vaccine, but not under Original Medicare Parts A and B. Instead, it is your Medicare Part D plan that is required to provide coverage for the shingles vaccines.
It’s a good thing that Part D covers shingles vaccines, because there is an estimated 1 million new cases of shingles each year in the United States. The risk of an outbreak increases with age, so people over the age of 65 are more susceptible than younger adults.
For this reason, many doctors encourage people on Medicare to get vaccinated. The age for shingles vaccine is 50 or older.
Where and How to Get Vaccinated for Shingles
Medicare requires all Part D plans to cover the shingles vaccine, so that’s the good news. However, since Part D plans have networks, you’ll want to be sure you get the vaccine in a pharmacy that is in the plan’s network.
If, on the other hand, your doctor vaccinates you, be sure to ask if his office staff can bill your Part D plan directly or coordinate with your in-network pharmacy to bill the plan. Missing these steps could result in you paying the entire bill and have to submit a reimbursement request to your plan.
How Much Does the Shingles Vaccine Cost?
Fortunately, there are a number of vaccines covered by Medicare Part D, including shingles vaccines which have been effective for many individuals. It’s important to note that your Medicare Part B does not cover the shingles vaccine. This means if your doctor administers it to you, and bills Medicare, it won’t be covered unless he can bill your Part D plan directly, as we mentioned above.
However, you can find Zostavax and Shingrix on your Part D plan formulary. Check your Part D drug formulary to see which tier the vaccine falls into. Most Part D plans will cover at least 50% of the cost of the vaccine.
According to a consumer report in 2018, Shingrix retails for around $280 for the 2 injections. Zostavax is slightly cheaper, retailing for around $220.
You will pay only a co-payment or co-insurance for your share of the vaccine cost. While our experience has been that most Part D plans cover about half of the cost of the shingles vaccine, there may be plans available in your area that cover more. Our team can help you find a drug plan that includes the shingles vaccine on its formulary.
If you do not have a Part D drug plan, check pricing on GoodRx.com, where you can find coupons that will save you a significant amount of money on this vaccine.
Does Medicare cover Shingrix?
Yes, all Medicare Part D plans cover this drug, and Medicare Advantage plans with built-in Part D coverage will also cover Shingrix.
Also, you may not need a prescription if you are paying for this drug yourself. Ask your pharmacist if they require you to get one.
Can you get shingles if you had the chickenpox vaccine?
It depends. Anyone who has ever had chicken pox is susceptible to shingles. When the chicken pox virus comes out of hiding and reactivates, it causes symptoms such as numbness, tingling, blisters, and also sometimes flu-like symptoms. If you never had chicken pox because you were vaccinated, you run a very low risk of getting shingles.
Pain and Complications of Shingles in Elderly People
Elderly people who develop shingles are often surprised at how painful it is. Many say that it is far more painful than the original chickenpox virus that affected them in childhood. Often the skin in the area of the rash continues to hurt even after the rash has healed.
The individual may feel stabbing or throbbing or even weakness. Doctors call this post-herpetic neuralgia, and it can sometimes last for months or even years.
There are also risks to older adults who develop shingles. The blistered area of skin can become infected, requiring antibiotics in addition to antivirals. Such infections can lead to scarring. The rash is also uncomfortable and makes it difficult to rest. When healing takes longer than normal, some individuals can feel despair or even depression. In rare cases, it can lead to encephalitis.
The virus can also be transmitted to other parts of your body, such as your eyes or lips. The herpes virus can cause outbreaks that may affect hearing and vision.
Another thing to be concerned about is contagion. While shingles itself is not contagious, the virus that causes it is. If your spouse has never had chickenpox and has not been vaccinated, he or she could develop chickenpox as an adult. It’s important to keep your skin clean and dry and prevent it from rubbing against any other person who could get infected.
Shingles Medicare Billing Problems
Just a quick reminder about a billing issue that we commonly resolve for our clients. Many doctors continue to bill this to Medicare Part B and then the bill get rejected. Once the rejection happens, far too many Medicare beneficiary just pay these bills without questioning them. One astute client remembered that our Client Service Team provides FREE help resolving bills like these and called us for support.
Her doctor’s office had tried to bill her $710 for this medication – which is ridiculous! The shingles vaccine costs between $200 – $300. Most Part D plans will pay 50% of that. So don’t pay any medical bills that you receive without checking with us first.
Do you have questions about which Medicare plans will cover the shingles vaccine? Or perhaps you need help finding a drug plan that includes other vaccines covered by Medicare Part D? Give us a call.