Health is the root of all happiness. When we grow older, shingles can affect us. The shingle is a viral infection that can result in a painful rash.
Most of the time, the shingles shot is very costly. But you can deal with the high cost with proper health insurance. If your health insurance includes Medicare Part D, in that case, the shingles shot is covered by it or Medicare Advantage as part of your benefits for prescription drugs.
During the covid 19, the health insurance plan helps me reduce the shingles shot cost. You may be surprised to know that it is worth it.
Are you looking for a health insurance policy that will assist you in reducing the cost of shingles shots?
Do not worry. You are in the right place to know, “does insurance cover the shingles shot.” Please read the article till the end to learn more about it.
Insurance’s funding process and shingles shot
Health insurance companies have many policies. Medicare Parts A and B do not provide coverage for the shingles shot; Medicare Part D does.
To cover the shingles, you must sign up for a Medicare prescription drug plan (PDP) or a Medicare Advantage plan. And it covers prescription drugs. There can be a copayment required for the shingles shot.
Types of shingles vaccines
The two available drugs for the shingles shot are Zostavax and Shingrix. According to the Mayo Clinic, Zostavax offers shingles protection for around five years. The live vaccination is administered as a single dose in the upper arm.
Adults over 60 should receive the Zostavax shingles vaccine. According to the Centers for Disease Control and Prevention (CDC), it reduces the chance of acquiring shingles by 51%. Studies show that Shingrix has offered shingles protection for over five years. It is a nonliving, two-dose vaccination.
Best medicare provider that covers shingles vaccination
Medicare Plan D offers coverage for the shingles shot. Coverage differs from business to business, and your real cost will depend on your plan’s specifics and whether your deductible has been reached.
Your greatest option for shingles vaccination coverage is a Medicare plan from Aetna or Wellcare. In both cases, a dosage of the shingles shot costs less than $50. The Medicare Plan D policies are reasonably priced. It costs around $36 to $37 a month.
I have mentioned some insurance companies’ names below with approximate shingles shot costs.
- Aetna Health Insurance: This insurance company is financially strong. Customers have mixed reviews about this insurance. The approximate cost of the shingles shot is $47.
- Anthem Health Insurance: This insurance is for those who need standard health insurance plans and coverage. You have to pay $31-$149 for getting shingles shot.
- Cigna Health Insurance: This insurance has a Cheap Medicare Advantage. You must pay $35-$159 under this insurance for the shingles shot.
- Wellcare Medicare: This WellCare is budget-friendly. You have to pay $28-$47 for the shingles vaccine.
- Kaiser Permanente Insurance: If you want strong preventive coverage, this insurance is for you. The shingles shot costs $150.
Who could have received the Shingrix vaccine?
Not everyone should get the Shingrix vaccine. Adults over the age of 50 should get the Shingrix shingles vaccination. In comparison to the Shingrix shingles vaccine, Zostavax is less efficient.
After two doses, Shingrix has a rate of more than 97% for preventing shingles in individuals aged 50 to 69. According to the CDC, persons aged 70 and older who receive the Shingrix shingles vaccination are 91 percent protected from developing shingles.
The CDC advises two doses of the RZV and Shingrix vaccines for persons over 50 to avoid shingles and associated side effects. Additionally, those over 19 with weakened immune systems are encouraged to get the vaccination.
Who shouldn’t get the shingrix vaccine?
If you have an allergic problem, then stay away from Shingrix Vaccine. You should also stop taking Shingrix Vaccine if you observe allergic reactions after taking Shingrix. And pregnant women should wait for a while to take Shingrix shots.
Side effects of the shingles shot
Numerous studies suggest that the Shingles shot is safe. You may experience some post-shot symptoms, including:
- Soreness around the shot site.
- Mild redness and swelling.
- Muscle pains and a headache.
- Fever.
- Stomach pain or nausea.
Age-related risk factors include prolonged pain duration. Shingles sometimes progress to pneumonia, hearing issues, blindness, and brain inflammation.
Cost of Shingles shot
The manufacturer of the Shingrix vaccine, GSK, reports that the Shingrix vaccine’s list price is $343.13, or $171.57 per dose, as of January 2022. This vaccine sold for more at pharmacies than the list price.
Your costs will vary depending on your health insurance status and plan. Shingrix retails for approximately $211 per dose, according to GoodRx. By using GoodRx, you can pay as little as $155 for each amount.
You must pay less than $50 per dose if you have Medicare Part D. Customers of the Affordable Care Act insurance plan get shingles shot as a preventive service.
Why does Medicare not provide the shingles shot to all seniors for free?
“Does insurance cover the shingles shot?” Yes, it does. Many believe that Original Medicare would cover the vaccine cost that the CDC recommends for people over 50. There are a few reasons why the two-dose regimen could cost you hundreds of dollars.
Level of medicare coverage: Cost-sharing benefits for some Medicare drug plans are better than others. Your shingles vaccine cost depends on which insurance plan you choose.
Classification of medications: The Shingrix vaccine is covered by Medicare as part of its pharmaceutical coverage. It would be covered by Medicare Part D rather than Part A or Part B.
On the other hand, most private health insurance plans, whether through an employer or the marketplace, include the shingles vaccine as part of their free preventative coverage.
Type of medication: There is no generic alternative to Shingrix, a GlaxoSmithKline Tier 3 medication. It may indicate that your out-of-pocket expenses exceed those of other medicines.
Process of getting the shingles vaccine for free
All Medicare prescription medication plans offer coverage for the shingles vaccine. A Medicare Advantage or your Medicare Part D plan offers this coverage.
Some members may receive a free shingles vaccination, while others may be required to pay the entire cost of a deductible that must be satisfied before cost-sharing benefits kick in.
If you have Medicare Part D coverage or no health insurance, you could be qualified for GSK’s Patient Assistance Program for Vaccines. And it will pay for or lower the price of the shingles vaccine.
State health agencies may provide free or inexpensive shingles vaccinations depending on household income. You could be qualified to obtain adult vaccination for free or at a reduced cost through your state’s health department or your local community health center.
You may get vaccination information from your state’s health department on the US Department of Health and Human Services webpage.
You might inquire with a local federally designated health facility or charity clinic. You can use locator tools provided by the Health Resources and Services Administration and the National Association of Free and Charitable Clinics to find a health facility.
To receive lower coverage, see if you are eligible for one of Medicare’s Extra Help programs. If you are qualified, these savings programs will reduce your cost.
Frequently Asked Questions
Thousands of questions can pop up in your mind while doing an insurance-covering shingles shot. I have discussed frequently asked questions about “does insurance cover the shingles shot.”
How can you save on the cost of the shingles vaccine?
Using the following suggestions, you may reduce the cost of your shingles vaccination.
Visit a pharmacy in your network with a prescription
You can visit your nearby pharmacy to receive your shingles vaccine. It might result in financial savings if you have a prescription medication plan. The doctor may charge you extra if you receive the vaccination in their office.
A better medication plan or enrollment in Medicare Part D
During open registration, you can select a prescription drug plan that covers Tier 3 medications like Shingrix. Keep in mind how much your drugs have cost the policy overall. Medicare Part D policies can also be complementary if you qualify for low-income subsidies.
Obtain a discount voucher for the shingles vaccine
Pharmaceutical networks and merchants may provide discounts on vaccinations. Usually, to enjoy the deals at the pharmacy, you must give a coupon or a medication discount card.
Use state program for medication assistance
Through a state program, you might be able to save money on prescription medications like the shingles vaccination.
Obtain assistance from the vaccine’s maker
GlaxoSmithKline offers the GSK Patient Assistance Program to those who satisfy specific criteria. You may qualify if your yearly income is under $32,200.
How much does the shingles vaccine cost?
The recommended two doses of Shingrix cost $324; the whole package costs $162.
Many Medicare users pay less than $50 for each shot. The coverage level depends on your prescription drug plan.
How many shots are needed for the shingles vaccine?
The Shingrix vaccination needs to be given twice for the best results. Generally speaking, these injections need to be given every two to six months.
Are seniors eligible for free shingles shots?
Not every senior is entitled to a free shingles vaccination. Whether you have a Medicare Part D plan or a Medicare Advantage plan that covers prescription medicines will affect the cost.
Seniors without prescription medication coverage will either pay the total price for the shingles vaccination or need to seek a cost-saving method to obtain it at a lesser cost.
What Problems Can Shingles Cause?
The most frequent and persistent side effect of shingles is postherpetic neuralgia (PHN). It is nerve pain that can last for months or even years after the rash has subsided.
The CDC estimates that between 10% and 18% of individuals with shingles will get PHN. PHN causes stabbing, throbbing, or weak pain where the shingles rash formerly existed.
Fewer than 100 individuals pass away with shingles each year, and only 1% to 4% of shingles patients require hospitalization for complications. These patients are mainly elderly adults and those with weakened or suppressed immune systems.
Does Medicare Plan A and B cover the shingles vaccine?
The shingles vaccine is not covered in Medicare Plan A and B. Medicare Plan a is hospital insurance. You will get a skilled nursing facility and home health care service in this plan.
Medicare Plan B is medical insurance. It includes doctor’s assistance. In this plan, you will also get home health care services.
How Often Can You Get Shingles?
Shingles can recur often. One research found that one in seven people will go through it once more in the next seven years. Most people who acquire shingles only have one episode in their lives, which is excellent news.
Which Medicare plans cover shingles shot?
Medicare plan D covers the shingles vaccination. If your health insurance plan includes Medicare plan D, you can reduce the cost of a shingles shots. But the price can vary from insurance to insurance.
Final Thoughts
Insurance will pay for the shingles vaccination if you have Part D prescription coverage via your Medicare or Medicare Advantage plan. If your deductible is not reached, you will be responsible for paying the full cost of the vaccination. A copay may be required for each of the two doses.
Your shingles vaccination is covered as preventative care under most commercial and employer-based health plans and the marketplace plans under the Affordable Care Act.
By this time you get the answer, “does insurance cover the shingles shot.” I hope this article will help you to deal with the shingles shot hassle. Still, if you have any queries, let us know in the comment section.
Mehedi Hasan is an insurance expert with over 6 years of experience in the industry. He has a deep understanding of various types of insurance policies and is skilled at helping clients find the coverage that best fits their needs. In his current role, Mehedi works as a consultant, advising businesses and individuals on the best insurance options for their specific situations.
He is also a frequent speaker at industry events, sharing his knowledge and expertise with colleagues and professionals in the field. Mehedi holds a degree in insurance and risk management and is committed to staying up-to-date on the latest industry trends and developments. In his free time, he enjoys reading, traveling, and spending time with his family.