Shingles Vaccination Not Covered for Some in Medicare; It is for Some Boomers
Seniors face many obstacles to getting needed vaccines, including the shingles vaccine
Sept. 14, 2012 The
shingles vaccine its cost, its coverage by Medicare, its coverage provided by Medicare supplement insurance, its coverage by the drug
program are frequent questions among senior citizens. This week the answers are provided by Michelle Andrews in her column for Kaiser News,
Insuring Your Health.
Q. I have Medicare and a Plan F Medigap plan, so I should be covered for all medical needs. But in
order to get the shingles vaccination, it will cost me $185. I can't pay this without using my grocery or prescription money. It's totally
unfair. What can I do?
Answer by Michelle Andrews -
Shingles is a painful rash caused by a virus that can lead to long-term nerve damage called postherpetic neuralgia. All Medicare
Part D prescription drug plans cover the shingles vaccine, which is
by the Centers for Disease Control and Prevention for people age 60 and older.
But Medigap plans, which may cover the deductible and coinsurance amounts for services provided under Medicare Parts A
and B (hospitalization and outpatient care), don't offer any financial help on the co-payments for vaccines and other drugs covered under Part
Accountability Office report published in December found that seniors faced many obstacles to getting needed vaccines, including
the shingles vaccine. Many physicians don't recommend or even stock the shingles vaccine, the report found. The amount that the patient pays
out of pocket for that vaccine could also be a barrier, according to the report.
If the only health coverage you have is through Medicare and your Medigap plan, there are still ways you may be able to
reduce your co-payment for the vaccine, says David Lipschutz, a policy attorney at the Center for Medicare Advocacy in Washington.
First, if you have Part D coverage, contact your plan to make sure the co-payment you're being quoted is accurate.
In addition, many doctors who don't stock the vaccine ask patients to buy it from the pharmacy. If that's the case, make
sure the pharmacy is in your plan's network so you'll owe a smaller co-payment than if you buy the vaccine from an out-of-network pharmacy,
If the vaccine co-payment is still too high, it may be worth looking into other Part D plans or signing up for one during
the upcoming annual enrollment period, Oct. 15 to Dec. 7. Depending on your other prescription drug needs
and coverage, you may be able to find a better deal, Lipschutz says.
It's worth noting that under the 2010 health care law, people who have new private health insurance plans and those whose
plan benefits have changed significantly are eligible to receive, free of charge, vaccines recommended by the CDC's Advisory Committee on
Immunization Practices. Plan members who are in their early 60s, therefore, might qualify for a shingles vaccine without a co-pay.
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