Does Medicare Cover Shingles Shots?
If you have encountered shingles or witnessed anyone dealing with it, then you know that there is nothing to be desired about it.
However, as you age, your chances of developing the condition increase, and as such, you may want to get vaccinated to avoid it.
You are probably wondering if your health cover can take the shots? Today, we are focusing on Medicare in particular and whether it covers the cost of shingles shots.
Stick around as we seek to find that out.
An Overview of Medicare
Medicare is a federal health insurance program for people age 65 and older who are disabled or have the end-stage renal disease (ESRD).
The Medicare program covers a broad range of medical services, and it does not charge premiums for enrollees.
However, certain copayments and coinsurance amounts are associated with certain medical services. As a result, some services are excluded from coverage altogether.
If you get shingles when you’re over 65, Medicare might cover the cost of a vaccine to prevent future cases.
However, if you have a secondary insurance policy, the shingles shot may be covered by that policy instead of Medicare.
If your employer offers health care coverage, that plan may also cover the cost of your shingles vaccine.
You can enroll in Medicare Part A after you turn 65 or become eligible for Social Security Disability Insurance (SSDI).
If you work while receiving ESRD benefits, your employer might provide additional coverage through Medicare Part A.
Your employer pays into the system each month on your behalf. In most cases, working while receiving Medicare will not affect your eligibility for the program.
Nonetheless, if your earnings surpass a certain threshold, Social Security might reduce your monthly benefits or stop paying them altogether.
Medicare coverage for shingles is available to people age 65 and older who have been Medicare-eligible for more than two years.
Medicare patients are required to pay 20% of the vaccine cost, which can run between $200 and $250.
Some insurance companies may cover this cost and cover other treatment options for shingles.
If you are unsure if your insurance will cover the cost of your shingles vaccination, be sure to contact your insurance provider before scheduling an appointment with a healthcare provider.
Treatment for Shingles
Medicare will only pay to treat shingles if they lead to pain that lasts longer than 90 days.
This is because there’s no cure for shingles—once you have it, you’re stuck with it! So if you can’t tolerate the pain without treatment, you’ll want to seek help from your doctor.
However, you want to note that Medicare will probably require you to try other medications first since it only covers treatments that are “medically necessary.”
Treatment for Side Effects
Most people will exhibit unpleasant side effects when they take medication to treat pain from shingles. These can include headaches, nausea, dizziness, or trouble sleeping.
Now, even though your physician may prescribe medication to help manage these side effects, Medicare will not pay for them.
What Happens If I Don’t Get Vaccinated?
If you don’t get vaccinated, you’ll have to pay for your prescriptions out of pocket. The cost of shingles shots can range from $150 to $200.
If you still want to get vaccinated, some programs can help you pay for the treatment even if you don’t have coverage through Medicare.
Such programs may also be able to help with your co-pays or other out-of-pocket expenses.
The Health Resources and Services Administration offers the Vaccines for Children program, which provides free vaccines to children who might not afford them otherwise.
You may qualify for this program even if you’re not a child anymore — especially if your income is low enough.
As you age, you become more susceptible to shingles, but the good news is that you can avoid the condition simply by getting vaccinated.
That said, Shingles costs are not as cheap, and you may want to have them covered by your insurance company.
Ultimately, Medicare Part A and B will not cover the cost of getting shots for the same. Nevertheless, you can get coverage through Medicare Part D or Medicare Advantage plan.