One of the most frequently asked questions from seniors is: Does Medicare Cover the Shingles Vaccine?

Shingles is a skin rash that is caused by the same virus that causes chickenpox. If you had chickenpox as a child and suffer from shingles one day, know that you got it from the same virus that caused chickenpox. Most adults who were born before 1980 had chickenpox as a child. That means they can get shingles later in life.

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The shingles vaccine is a must for anyone over 50. In America, one out of three people will develop shingles in their lifetime. There is no cure, but the Shingrix vaccine is FDA approved and available now. The vaccine is also stocked in most pharmacies across the country. No other option is as effective and reliable as Shingrix.

You have two options to get coverage if you receive the shingles shot(s) and you are on Medicare: get a stand-alone Part D prescription drug plan or sign up for Medicare Part C prescription drug coverage that is offered with Medicare Advantage.

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Why Should I Get the Shingles Vaccine?

A shingles outbreak is painful! Shingles is a common viral infection characterized by an itchy or burning rash with blisters. It’s usually located in one part of the body, like the chest, abdomen, or face. It takes seven to 10 days for the blister to scab over and clear up in two to four weeks.

The Centers for Disease Control and Prevention (CDC) recommends that anyone over the age of 50 should get the shingles vaccine since Shingles is most common among people in that age group.

You can’t pass shingles to someone else, but you can transmit the virus that causes it if another person comes into contact with the fluid from the blisters. This person would then develop chickenpox if they’ve never had it before or never received the chickenpox vaccine.

How Much Does the Shingles Vaccine Cost?

People with Medicare Part D will pay an average of $50 per shot ($100 for the 2-shot recommendation) for Shingrix, according to GlaxoSmithKline who manufactures the vaccine.

There are many “discount cards that can help with the price.  One of the largest, GLicRX has prices as low as $160.00 (depends on location) That’s 23% less than its retail price of roughly $206. Medicare Part D typically lists Shingrix as a Tier 3 drug in their formularies.

There are different factors that come into play when determining how much your vaccine will cost. Ultimately, the cost is based on the Medicare prescription plan you choose, the vaccine you get, and the pharmacy or doctor’s office where you have it administered. If the price is unaffordable for you, there are different programs out there that may be able to help. One such program is GSK for You.

Does the Shingrix Vaccine Cause Side-Effects?

Shingrix is in a league of its own in vaccine effectiveness. It’s the only recombinant and adjuvanted (meaning it helps the body to produce greater immunity to infections) vaccine on the market. Not only is it over 97% effective in adults aged 50 and up, but it has been shown to remain at 85% effectiveness in all four years following vaccination.

In published studies, it’s been shown that seven in 10 people experience pain from the Shingrix vaccine. In one study, nearly half of people with the vaccine had muscle pain or fatigue and experienced headaches, shivering, fever, or nausea. The CDC suggests avoiding strenuous activity for two to three days after the vaccine is administered.

The Centers for Disease Control and Prevention (CDC) recommend Shingrix as a replacement for Zostavax if it has been five or more years since you received the first vaccine.

The CDC also states that there is no data or theoretical concerns that Shingrix would be any less effective if given sooner. Zostavax was discontinued by Merck in 2020 and is no longer available in the United States.

Does Medicare Cover the Shingles Vaccine?

Although Original Medicare Part A and Part B do not cover the cost of the shingles vaccine, Medicare Part D (prescription drug plan) does cover most of the retail cost of Shingrix, the approved vaccine for shingles.

The issue is that the shingles vaccine is a “Tier 3” medication and if you have a deductible, you will pay that first.  This makes it look like the prescription isnt covered, because the deductible in normally more than the cost of the shots.

Medicare Part D plans differ from plan to plan so it’s important that you ask your agent what the coverage is for Shingrix since you will likely be needing the vaccine during your lifetime.

However, if you are enrolled in a Medicare Advantage plan that includes prescription drug coverage, you will have coverage for Shingrix (the shingles vaccine).

Depending on the Medicare Part D plan or Medicare Advantage plan you’re enrolled in, there are typically copays, coinsurance, or deductibles that will need to be paid out-of-pocket when you get your vaccine.

Choosing the right insurance plan can be tricky, but the first step is comparing formularies to find the one that covers as many of your medications and vaccinations as possible. Medicare Customer Support is also available to help you figure out which coverage will work for you.

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How to Find Prescription Drug Coverage that is Right for You

Finding prescription drug coverage that is the best fit for your circumstances and budget is easier today than ever before. 21st-century technologies allow independent insurance brokers to represent multiple companies and find the best insurance solution for clients and prospective clients.

An independent insurance broker like MyMedicareSupplementPlan.org offers Medicare Part D, Medicare Supplement Plans, and Medicare Advantage plans across the country. Although they represent most of the highly-rated companies that are approved to offer Medicare plans, they are an independent brokerage firm that is not employed by any of the companies they represent.

Their independent status allows the insurance professionals at Medicare Solutions Team to service their clients with expert advice and affordable Medicare products that will meet the needs and budget of their clients.

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