Will Medicare Cover My Shingles Vaccine?

Original Medicare, Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) do not cover the shingles vaccine. However, the right Medicare Supplement Plans will cover shingles shots and other vaccines.

Medicare Part D, Medicare's prescription drug plan that you can purchase with Medicare or Medicare Advantage, covers the vaccine, but otherwise you will likely have to pay out of pocket. If you haven't hit your plan's deductible for the year, you will pay the full price for the vaccine.

What is shingles?

Shingles is a viral infection caused by the varicella-zoster virus, which also causes chickenpox. If you've had chickenpox before, the virus can remain dormant in your nerve tissue near the brain or spinal cord. After many years, the virus may reactivate as shingles, which causes a rash that can be very painful, but it is not life-threatening. However, shingles can lead to complications.

Symptoms

Shingles usually appear in small areas of the body as red rashes that can itch, tingle, or burn. You might also find blisters, or the area is very sensitive to the touch. Some people also experience fever, headaches, sensitivity to light, and fatigue.

Sometimes shingles can be mistaken for heart, kidney, or liver problems if the pain manifests near those organs.

Treatment

There is no cure for shingles, but there are treatments available that your doctor will be able to recommend. Shingles usually goes away on its own after 2-6 weeks and only manifests once, but it can resurface multiple times.

Complications

One of the most common complications is postherpetic neuralgia, which causes the pain to persist even after the blisters have cleared. Shingles can also cause skin infections if not properly looked after, and in some cases lead to visual complications and neurological damage, depending on what areas of the body are infected.

Are shingles contagious?

Shingles itself is not contagious, as it only manifests in someone who has had chickenpox. However, the virus itself could be spread to anyone who is susceptible to chickenpox if they came into direct contact with an oozing shingles blister.

It is recommended to keep the infected areas clean and covered, and to wash hands regularly. Anyone with shingles symptoms should avoid contact with pregnant women, newborns, and children who have not yet been vaccinated.

Many Americans have had chickenpox as a child (before CDC-recommended chickenpox vaccines were widely available and distributed as they are today) which is why shingles is so common among people over the age of 50. The risk of shingles increases with age and when a person's immune system is weakened or compromised.

Should I get a shingles vaccine?

Shingles vaccines can help reduce the risk of shingles and complications. The vaccine is not known to cause severe side effects, but the most common are headaches, redness, tenderness, swelling and itching at the injection site. Always consult your doctor about which vaccine(s) you should take. 

Where can I get a shingles vaccine?

You will need a doctor's prescription for a shingle's vaccine, and you can get one from most retail pharmacies or at the doctor's office. If you go to a pharmacy, make sure the store is in the network of your plan. If you get your shingles vaccination at the doctor's office, see if the doctor can bill your drug plan directly. That way, you will only owe your copayment. Otherwise, you may need to pay the full cost up front and then file a claim for reimbursement from your insurance plan.

Also be sure to check with your doctor about excess fees, which can be 15% more than Medicare's allowable charge. If you do not have a Medicare Supplement Plan that covers excess fees, you may owe the difference.


Costs of the shingles vaccine can vary, but without insurance coverage the average cost is around $190, according to GoodRx.

If you're over 50, getting the shingles vaccine is generally recommended so that you can save yourself pain, discomfort, and complications down the road. Always be sure to consult with your doctor before getting any vaccine and ensure that you will have plenty of time to rest and recover from it.

Source: iQuanti, Inc.

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Categories: Healthcare Insurance

Tags: healthcare, healthcare insurance, medicare, vaccines