Understanding Medicare’s Coverage of the Shingles Vaccine
The Importance of Vaccinations and Medicare Coverage
Vaccinations play a crucial role in maintaining individual and community health. Medicare covers various vaccines such as the flu shot, hepatitis B, pneumococcal shots, and the COVID-19 vaccine. One important vaccine for older adults is the shingles shot, which Medicare Part D covers. This article delves into what you need to know about Medicare and the shingles vaccine.
Shingles Explained
Shingles, or herpes zoster, develops from the varicella zoster virus, the same virus that causes chickenpox. If you’ve had chickenpox, the virus remains dormant in your body and can later reactivate as shingles. Symptoms include a painful rash, fever, headache, chills, and upset stomach. About one in three Americans will develop shingles in their lifetime.
Understanding the Shingles Vaccine
The shingles vaccine, also known as Shingrix, is recommended for adults over 50. It’s given as a shot in the upper arm and is available at doctors’ offices and pharmacies. Side effects are generally mild and temporary, such as soreness at the injection site, muscle pain, fatigue, and sometimes fever or stomachache.
Postherpetic Neuralgia (PHN)
Shingrix also protects against PHN, a long-term nerve pain condition that can occur after shingles. PHN is more common in older adults and can be debilitating. Two doses of Shingrix are over 90% effective in preventing shingles and PHN.
Who Should Get the Shingles Vaccine?
Adults over 50 should receive two doses of Shingrix, spaced two to six months apart. It’s recommended even for those who’ve had shingles before, had the Zostavax vaccine, or aren’t sure if they’ve had chickenpox.
Who Should Avoid the Shingles Vaccine?
Certain people should not get Shingrix, including those with severe allergies to its components, those who have never had chickenpox, people currently experiencing shingles, and those who are pregnant or breastfeeding. Individuals with weakened immune systems should consult their doctor first.
Medicare Coverage for the Shingles Vaccine
Original Medicare does not cover the shingles vaccine. However, Medicare Part D plans cover it as they include all commercially available vaccines needed to prevent illness.
Medicare Part D: Prescription Drug Coverage
Medicare Part D covers the cost of the shingles vaccine. Be sure to check your specific plan for details.
Medicare Advantage and Shingles Vaccines
Medicare Advantage plans often include Part D coverage, so the shingles vaccine is likely covered under these plans. Always confirm with your insurance provider.
Shingles Vaccine Costs
Since January 2023, the Inflation Reduction Act has made many vaccines, including Shingrix, more affordable under Medicare and Medicaid. Coverage may vary, so it’s important to check with your provider. Most states cover Shingrix under Medicaid, but this varies.
Help with Shingles Vaccine Costs
If you need help paying for the shingles vaccine, pharmaceutical companies like GlaxoSmithKline (GSK), the manufacturer of Shingrix, may offer assistance programs.
FAQ: Effectiveness of the Shingles Vaccine
The protection from Shingrix lasts for up to 10 years after receiving the recommended doses.
