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Shingles, also known as herpes zoster, are caused by the same virus that causes chickenpox. If you had chickenpox as a child, as 99% of Americans born before 1980 did, the virus could reactivate when you are an adult and cause painful lesions of the skin.
One out of three people in the U.S. will develop shingles in their lifetime, and the risk increases as they get older.
There’s no cure, but there is one FDA-approved vaccine – Shingrix, that can protect you. As you get older, you’re more likely to get shingles.
Fortunately, there is a vaccine that can prevent the condition. The question is whether having Medicare insurance can help pay for the shingles shot.
Table of contents
- What is Shingles Shot?
- How Much Do The Shingles Shot Cost?
- Why Do You Need the Shingles Shot?
- Does Medicare Pay For Shingles Shot?
- How Much Does the Shingles Shot Cost with Medicare?
- How Can You Get Shingles Shot?
- What Parts Of Medicare Cover The Shingles Vaccine?
- Which Medicare Providers Cover The Shingles Vaccine?
- How Can You Save on the Cost of the Shingles Shot?
- Conclusion
- Frequently Asked Questions
- References
- Recommendations
What is Shingles Shot?
Shingles are a painful reminder that herpes zoster, the virus that causes chickenpox, is present in the body. About 99% of Americans 40 years and older have had chickenpox.
Shingles affect one-third of people who have had chickenpox, leading to burning, tingling, and shooting nerve pain. The symptoms can last for 3 to 5 weeks.
Even when the rash and nerve pain go away, you can still get postherpetic neuralgia. This is a type of pain that lingers where a shingles rash begins. Its symptoms include- anxiety, depression, problems completing daily activities, problems sleeping, and weight loss.
The Centers for Disease Control and Prevention (CDC) 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.
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How Much Do The Shingles Shot Cost?
The cost of the shingles shot depends on whether you have insurance. If you have insurance, it will depend on how much your Medicare plan covers.
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. The price range for the Shingles shot – Shingrix was given as two shots are-
- Deductible copay: free to $164 for each shot
- After you meet the deductible: free to $164 for each shot
- Donut hole/coverage gap range: free to $74 for each shot.
- After the donut hole: $7 to $8
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Why Do You Need the Shingles Shot?
There are several reasons you need the shingles shot, but the most common reason is the pain that comes with it.
Shingles commonly appear 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. Other reasons you should take a Shingles shot are:
- Shingles are most common among people over the age of 50, so the Centers for Disease Control (CDC) recommends the vaccine for anyone over that age to avoid the breakout altogether.
- If you have a weak immune system, you are at higher risk, and you should consider taking the Shingles Shot.
- If you are close to 50 and are under extreme stress, have an infection, or have an immune system disease like HIV/AIDS, you should consider getting the Shingles shot to avoid it’s coming at all.
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Does Medicare Pay For Shingles Shot?
Medicare prescription drug plans (Part D) cover all commercially available vaccines needed to prevent illness.
Unlike some common vaccines, like those for the flu, hepatitis B, and pneumonia, they do not cover shingles shots under Medicare Part B, the component of original Medicare that includes doctor visits and outpatient services. Part A, which deals with hospital costs, doesn’t cover shingles shots either.
Medicare coverage for Shingrix and Zostavax, the two commercially available shingles vaccines, is provided only if they enrolled you in a stand-alone Part D drug plan or a Medicare Advantage plan that includes Part D drug coverage.
Medicare requires Part D plans to cover the shingles vaccine, so if they enrolled you in Part D, you should not have difficulty getting the shot. Most require a copayment, which can vary widely from plan to plan.
However, if you have not met your plan’s deductible for the year, you would most likely pay the full price.
For Shingrix, the newer vaccine, that averages around $190, according to GoodRx, a website and app that tracks prescription prices.
The amount you pay will vary based on your policy details and your deductible amount. For some enrollees, the shingles vaccine could be free, but others may pay full price if they must meet a deductible before the cost-sharing benefits begin.
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How Much Does the Shingles Shot Cost with Medicare?
Most people who are enrolled in Medicare Part D pay less than $50 per dose for Shingrix, according to the vaccine’s manufacturer GlaxoSmithKline.
However, your costs will vary based on the plan’s details and if you have already met your deductible amount by purchasing other prescription drugs.
If you do not have a prescription drug plan or you have not met your plan’s deductible, the retail cost for the shingles vaccine is $162 per shot in 2021.
For the two-dose sequence, the total cost is $324. If the full price of the shingles vaccine is out of your budget, there are several ways you can save money on the vaccine.
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How Can You Get Shingles Shot?
You can get a shingles vaccine in two ways:
At the Pharmacy:
You would however need a doctor’s prescription, but once that’s been transmitted, you can get 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 plan’s network so that it can bill your plan directly, and you’ll owe just the copayment.
At The Doctor’s Office:
If you’re vaccinated in a doctor’s office, check whether it can bill your drug plan directly or works with a pharmacy that can do so.
Hence, it will work as mentioned above, with you owing a copayment. If not, you may need to pay the full cost upfront and then file a claim for reimbursement from your plan.
What Parts Of Medicare Cover The Shingles Vaccine?
Original Medicare- Part A (hospital coverage) and Part B (medical coverage)- doesn’t cover the shingles vaccine. However, other Medicare plans may cover at least part of the costs.
These include:
- Medicare Part C. Medicare Advantage (Part C) is a plan you can buy through a private insurance company. It may offer additional benefits not covered by Original Medicare, including some preventive services.
- Medicare Part D. This is the prescription drug coverage portion of Medicare and typically covers “commercially available vaccines.” Medicare requires Part D plans to cover the shingles shot, but the amount it covers can be very different from plan to plan.
To make sure you are covered, ensure you call your doctor to find out if they can bill your Part D plan directly.
If your doctor cannot bill your plan directly, ask your doctor to coordinate with an in-network pharmacy.
The pharmacy might be able to give you the vaccine and bill your plan directly. File your vaccine bill for reimbursement with your plan if you can’t do either of the options above.
If you have to file for reimbursement, you may have to pay the full price of the shot when you get it. Your plan should reimburse you, but the amount covered will vary based on your plan and if the pharmacy is in your network.
Which Medicare Providers Cover The Shingles Vaccine?
Even though all insurance plans for Medicare Plan D offer some level of coverage for the shingles vaccine, the typical cost for the vaccine will vary.
Your actual cost will depend on your plan details and if you have already met your deductible.
The Medicare providers that cover the Shingles vaccine are:
- AARP Medicare $45-$160
- Aetna Medicare $47
- Anthem Blue Cross Medicare $31-$149
- Cigna Medicare $35-$159
- Humana Medicare $42-$159
- Kaiser Permanente $150
- SilverScript Medicare $59-$77
- Tufts Medicare $0-$151
- UnitedHealthcare Medicare – $160
- WellCare Medicare – $28-$47
How Can You Save on the Cost of the Shingles Shot?
Asides from the Medicare insurance plan, there are other ways you can get the Shingles Shot.
Some of the tips on saving cost for your Shingles shot are:
- Visit an in-network pharmacy with a prescription: If you have a prescription drug plan, you could pay less for your vaccine by having it administered at an in-network pharmacy. Getting shot at a doctor’s office may lead to an additional doctor’s fee for administering the vaccine.
- Improve your drug coverage: During open enrollment, you can select a prescription drug plan that covers Tier 3 drugs, including Shingrix.
- Get a discount coupon for the shingles vaccine: Pharmaceutical retailers and networks may offer vaccine discounts. Usually, you would present the coupon or the drug discount card at the pharmacy to get the savings.
- Use a state pharmaceutical assistance program: A state program may be available to help you reduce the cost of prescription drugs, including the shingles vaccine.
- Get assistance from the vaccine maker: GlaxoSmithKline offers the GSK Patient Assistance Program for those who meet certain criteria, and you may qualify if you earn less than $32,200.
Conclusion
You can get shingles more than once. One study reported the odds of getting it again to be nearly 5% within seven years of the first incident.
But the good news is that most people who develop shingles only experience one episode in their lifetime. If you are above the age of 50 and have Medicare insurance, you should work on getting a Shingles Shot.
Frequently Asked Questions
Are shingles shot free for seniors?
The shingles vaccine is not free for all seniors, and how much you pay will depend on your Medicare Part D plan or with your Medicare Advantage prescription drug benefits. Seniors who don’t have a prescription drug plan will have to pay full price for the shingles vaccine or use a cost-saving method to get the vaccine at a discounted price.
Does Medicare Part B fully covers the pneumonia vaccine
Medicare Part B fully covers the pneumonia vaccine at zero cost. The shingles vaccine falls under your prescription drug plan, and you could be covered if you have Medicare Part D or a Medicare Advantage plan that includes Part D.
What medicare cover
They cover most adults 50 years and older shingrix patients typically pay no out-of-pocket costs per dose.
Yes. 100% of Medicare prescription drug plans cover this drug.
The cost for the Shingrix vaccine ranges from $0 to $164.
References
- https://medicareguide.com/medicare-shingles-vaccines-227223
- https://www.verywellhealth.com/does-medicare-cover-the-shingles-vaccine-5214554
- https://hcpnv.com/blog/does-medicare-cover-the-shingles-vaccine-will-i-have-to-pay-for-the-shot
- https://www.medicareplans.com/does-medicare-cover-the-shingles-vaccine
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