Shingles and chickenpox are caused by the virus — the varicella-zoster virus. After chickenpox, the virus becomes inactive for many years until something triggers it.
When it is reactivated, the condition will be called shingles and it also causes a painful rash. Shingles typically appear during your adult life. To avoid it, though, you may get vaccinated. But does Medicare cover the shingles vaccine?
Thankfully, Medicare covers the shingles vaccine. However, it is not part of Original Medicare Parts A and B. Rather, the Part D plan will pay for the cost of the shingles vaccine.
An estimated 1 million new cases of this condition are recorded per year in the US alone. The risk of an outbreak can increase with age. Thus, people over the age of 65 are likely to catch it than younger adults.
If you have Medicare and you don’t have a shingles vaccine yet, then you should consider getting one. Doctors recommend getting vaccinated when you reach the age of 50 or older.
How to Get the Vaccine for Shingles?
All Part D plans will have shingles vaccine coverage, regardless of where you purchase the plan from. But Part D plans have networks. In that case, you need to obtain the vaccine from a drugstore that is part of your insurer’s network.
Your doctor may offer a shingles vaccine in his office. But before you obtain it, make sure that his office is allowed to bill your Part D plan directly. You must clear it before you get vaccinated.
If your doctor can’t bill your plan, then you will have to pay the entire cost of the vaccine and send a reimbursement request to your insurer.
Medicare Part D includes several vaccines, depending on your plan. These vaccines include the shingles vaccine. Since Medicare Part B doesn’t cover the shingles vaccine, your doctor can’t bill Medicare. Rather, he must bill your Part D plan directly.
You may study your Part D plan to find out what level the Zostavax and Shignrix fall into. The majority of Part D plans can pay up to 50% of the entire vaccine cost. However, you must call your insurer’s customer support team to find out how much coverage you can get from your plan.
In 2018, the cost of Shingrix was around $280. The cost is for two injections. Zostavas is cheaper because it is available at $220.
Since Part D plans don’t cover the entire cost of the vaccine, you will have to pay a co-payment or co-insurance. It’s your share of the cost.
Although most Part D plans can pay up to 50% of the entire shingles vaccine cost, your plan may give you more coverage. if you wish to find a drug plan that can pay for a shingles vaccine, please give us a call.
On the other hand, if you don’t have a Part D plan, you may check out the pricing of the vaccine on goodrx.com. Not only you can find the cost of the vaccine there but you can also find coupons that can help you in lowering the entire cost of this vaccine.
Does It Require Prescription to Get Coverage for Shingrix?
All Medicare Part D plans cover this type of drug. If you have a Medicare Advantage with Part D coverage, then this health plan will include Shingrix.
Regarding prescription, you may or may not need a prescription if you will pay for it using your own money. But you must ask your pharmacist on how to obtain it or if you need a prescription from your doctor.
Will Shingles Occur if You Had Chickenpox Vaccine?
If you had chickenpox, then you are highly likely to develop shingles in the future. When the virus reactivates, it can cause various symptoms, like blisters, tingling, and numbness. It also causes flu-like symptoms.
On the other hand, if you were vaccinated and you didn’t have chickenpox, then you are not likely to get shingles. However, it is still possible to get shingles even if you didn’t contract chickenpox.
What are the Complications of Shingles in Seniors?
Shingles can cause a painful rash. Seniors say that this condition is worse and more painful than chickenpox. Some of them stated that the pain remains even though the rash has been healed.
The pain can be described as stabbing or throbbing. In some cases, the pain can last for months or years.
If you develop shingles, the blistered part of the skin can get infected. As a result, you may require antibiotics on top of the antivirals that you need. But this infection can cause scarring. Because the rash is, too, painful, it makes it difficult for you to rest.
Some seniors become depressed because healing from this condition is longer than when they had chickenpox. The infection can even lead to encephalitis, but this case is rare.
If it is not treated properly, the infection can affect your eyes or lips. It can affect your hearing and vision. But it only happens in severe cases.
Another problem with this condition is that the virus itself is contagious. In that case, if your spouse has not experienced chickenpox before and didn’t have the vaccine, then he/she is likely to develop it as an adult.
For that reason, when you contract this virus, make sure that you keep your skin dry and clean. You must not allow other people to touch you.
Medicare Billing Problems Related to Shingles
As mentioned earlier, Medicare Part B doesn’t cover the shingles vaccine. But many doctors bill their patients’ Part B for it. When it is rejected, seniors simply pay for the entire cost of the vaccine without having to question their insurer.
Some doctors will even bill you twice the cost of the vaccine. For that reason, you must ensure that you talk to us first before you pay your medical bills. Our team here is ready to give you free consultation should you need help in understanding your medical bill.
For further questions about “Does Medicare cover the shingles vaccine,” please give us a call today. Our team of health insurance experts will be happy to assist you.