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 primarily for people 65 years of age or older, but it also covers younger individuals with disabilities and those with End-Stage Renal Disease (ESRD). The program provides several medical services.
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.
- Medicare Part D covers the shingles vaccine for those enrolled in a Medicare prescription drug plan, regardless of age.
- In contrast to the Medicare program, if you have any additional insurance, it may provide coverage for your shingles shot.
- You might also be eligible for shingles vaccination coverage under your employer’s health plan.
What Medicare Cover Shingles Shots?
What is Shingles?
Shingles is a 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. Depending on their severity, these symptoms may last three to five weeks.
You can still develop postherpetic neuralgia even after the pain and rashes disappear with time. Postherpetic neuralgia may cause the following symptoms-
- Depression
- Anxiety
- 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.
Does Medicare Cover Shingles Shots – The Cost Estimation of Shingles Vaccination
According to the GlaxoSmithKline report, Shingrix retails for an average of $171.57 per dosage and $343.13 for the two-dose series. However, the price may vary in different locations.
When you obtain a vaccination, your healthcare practitioner may charge an extra fee to administer it, which can increase the 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.
In Medicare drug programs, medication groups are created by tier. The cost of medicine might vary depending on where it sits on the tier. Medicare Part D plans cover the shingles vaccine, but the exact coverage and out-of-pocket costs can vary by plan.
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, depending on their Medicare plan, some may have to pay around $200.
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.
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 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 generally includes commercially accessible immunizations.
Starting January 1, 2023, the Inflation Reduction Act, out-of-pocket cost for shingle vaccine for people with Medicare Part D is eliminated. (1)
Where Can You Receive Vaccination for Shingles?
The CDC recommends the Shingrix vaccine for adults 50 years and older and for adults 19 years and older with weakened immune systems due to disease or therapy.
You should not receive the vaccination if you are extremely allergic to any of its components or if tests show that you do not have antibodies to the varicella-zoster virus. Pregnant women must also consult a medical professional before receiving the shingles vaccination.
If you meet the requirements for the vaccination, you can pick the location where you receive it.
Doctor’s office
Vaccinations are available at your doctor’s office. If the clinic is set up to charge Part D directly for your vaccination, you may only have to pay a copay at the time of your shingles vaccine.
Otherwise, you may have to submit a claim to your Part D plan and pay all the costs.
Local pharmacy
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. Pharmacies may bill Medicare Part D plans directly for covered vaccines, including the shingles vaccine, but patients may have out-of-pocket costs depending on their specific Part D plan coverage.
Conclusion
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.
Medicare Part C and Part D plans cover the shingles vaccination program so you can lead a healthy life.
See Also
Does Medicare Cover Hearing Aids
Does Medicare Cover Cataract Surgery
Dermatologists That Accept Medicaid
Does Medicare Cover Chiropractic
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