Does Medicare Cover Shingles Shots?
You are more likely to develop shingles as you grow older. However, there is a medication that can decrease the risk of a shingles outbreak. You can receive shingles prevention coverage depending on your Medicare type.
An Overview of Medicare
Medicare is a federal health insurance program for people with disabilities or ESRD (End Stage Renal Disease) who are 65 years of age or older. You can receive several medical services with the Medicare coverage program.
Yet, some of the medical services are completely excluded from coverage. At the same time, certain medical procedures come with specific copayment and coinsurance levels.
- If you are over 65 and get shingles, you may receive vaccine coverage from Medicare.
- In contrast to the Medicare program, if you have any additional insurance, it may provide coverage for your shingles shot.
- You might be eligible for shingles vaccination coverage under your employer’s health plan as well.
What is Shingles?
Shingles is a type of viral infection that can cause a burning and painful skin rash. Depending on the color of your skin, the rash may be red, dark pink, dark brown, or purple and usually only affects one side of the body.
It can also cause a tingling sensation and nerve pain. These symptoms may last for three to five weeks, depending on their severity.
You can still develop postherpetic neuralgia even after the pain and rashes disappear with time. Postherpetic neuralgia may cause the following symptoms-
- Sleeping problem
- Weight loss
- Daily activities that cause problems
The Cost Estimation of Shingles Vaccination
The only shingles vaccine available in the US is called Shingrix. Instead of a live virus, a protein from the virus is used in the vaccine to start an immune response.
According to the GlaxoSmithKline report, Shingrix costs an average of $171.57 per dosage and $343.13 for the two-dose series at retail. However, the price may vary in different locations.
Your healthcare practitioner may charge an extra price to administer a vaccination when you obtain one. It can increase your overall expense of the vaccine.
What is the Cost of Shingles Vaccination with Medicare?
The cost of the shingles vaccination may vary depending on how much of it is covered in your Medicare plan. However, you may have to pay the entire cost of the vaccination if you have original Medicare and no prescription medication coverage via Medicare.
Medication groups are created by tier in Medicare drug programs. The cost of medicine might vary depending on where it sits on the tier. Most Medicare medication plans to pay at least 50% of a drug’s retail cost.
You may receive coverage for the Shirgrix vaccine from most private health insurance programs. However, according to the Centers for Disease Control and Prevention, most of them do not cover the entire cost.
Patients with Medicare coverage mostly pay $50 out-of-pocket for the shingles vaccination. However, some of them may have to pay around $200, depending on the Medicare plan.
Some patients can obtain the shingles injection even if they do not have private insurance or Medicare Part D; some pharmaceutical firms even offer it for free.
What Medicare Covers the Shingles Vaccine?
There are four different types of Medicare plans available in the US. In 1965, the first Medicare provisions to be codified into law were Parts A and B. Usually, the government is in charge of them.
However, shingles vaccination does not come under Medicare Part A and Part B.
Two other Medicare parts offer coverage for shingle vaccination-
#1. Medicare Part C
You can buy a Medicare Part C plan through a specific private insurance company. With this plan, you can receive some preventive services and additional benefits that are not included in the original Medicare program.
Some of these plans offer prescription drug coverage, including shingles vaccination.
#2. Medicare Part D
Part D program is Medicare’s prescription medicine coverage program, which normally includes commercially accessible immunizations.
Starting January 1, 2023, the Inflation Reduction Act, a new law introduced by President Biden, was passed to make the shingles vaccination free to all seniors and people with disabilities.
Where Can You Receive Vaccination for Shingles?
The Shingrix vaccine is recommended by the Centers for Disease Control and Prevention (CDC) for adults 50 and older and kids 19 and older with weaker immune systems.
You should not receive the vaccination if you are extremely allergic to any of the vaccine’s components or if tests show that you do not have antibodies to the varicella-zoster virus. Before receiving the shingles vaccination, pregnant women must also consult a medical professional.
If you meet the requirements for the vaccination, you can pick the location where you receive it.
Vaccinations are available at your doctor’s office. At the time of your shingles vaccine, you may only have to pay a copay if the clinic is set up to charge Part D directly for your vaccination.
Otherwise, you may have to submit a claim to your Part D plan and pay all the costs.
If your neighborhood pharmacy offers the vaccination and has qualified staff members to deliver the vaccine, you are welcome to go there to obtain your shingles dose.
The rules and regulations for pharmacy vaccination are different in every state. Legally, pharmacies are not obligated to give out drugs to customers without payment.
Shingles is a serious medical condition that may harm your body if not treated properly. However, if you are qualified for Medicare and unable to pay for the vaccination, you need not be concerned.
You can get coverage for the shingles vaccination program and lead a healthy life with the Medicare Part C and Part D plans.