Shingles vaccine

[Teacher Terry]

My hubby got shingles & it was very painful in addition to leaving a scar on his face. I was going to get one but then read that if you are allergic to neomycin do not get one.

 

[Bikerdude]

It's refrigerated, but it only takes a few minutes to mix it up. I called (not Costco) first to make sure they had it in stock, then went over. No appt. needed.

The group plan that we have covers 100% as preventative all CDC-recommended vaccinations. I just look up the latest chart on CDC's website. When I go into the pharmacy or Minute-Clinic, they run my ins. card to verify with our ins. co. that it is indeed 100% covered, before they do anything.

When I had the shot at a chain pharmacy I could swear he took something off the shelf before I received the shot. Maybe it was the syringe. From what I read the zoster vaccine must be kept frozen until reconstituted and then used within 72 hours.

 

[ERD50]

Got my shot today, after years of procrastination.

Two weeks ago, I called my insurance co to make sure it was covered, they said yes (after a long hold). I made sure that Costco was a place I could go (got prescriptions filled there before), they said yes (after more holds). I asked, no co-pay, no $ at all? They said yes, immunizations are 100% covered as 'preventative'. OK. And later, I find this in my plan booklet that I downloaded.

Well, Costco rings it up at $217.xx they said the ins co listed it as a 'plan exemption'. Hmmm. I decide to pay now, get the shot, and challenge the ins co for a reimbursement. Will make that call tomorrow.

I'm actually OK paying out of pocket, based on what I've heard from people who have had shingles. But if the ins said they'd pay, they better pay.

Also, when they gave me the shot, they made a big deal about how it is going to sting. Well, I'm pretty much a wimp on these things (though shots or giving blood don't bother me much), but the sting was pretty mild and short lived. No soreness at all at this point. Hopefully no problem tomorrow, though dealing with the ins co will not be good for my blood pressure.

-ERD50

 

[audreyh1]

I got my shot today at Costco. I promised myself I would get it when I was 55 and my year is almost up!

After waiting (shopping) 15 mins while they got stuff ready, I was completely blown away when they told me I owed $0. I was totally expecting to pay for this since I am on a high deductible health insurance plan (HSA compatible).

Luckily Costco had my insurance on file and checked for me while I was off shopping. I just assumed it would not be covered since I was under 60, as that is what happened to my husband 2 or 3 years ago.

Apparently BCBS has changed their policy!!! The pharmacist said he thought insurance companies had been under a lot of pressure since the FDA reduced the age for the vaccine to 50.

It would have cost $240.

There was a syringe and two vials (one with silver or white seal, one green), FWIW.

If we find out in 10 years that I need another one or some kind of booster - no prob.

 

[bmcgonig]

I got my shot today at Costco. I promised myself I would get it when I was 55 and my year is almost up!

After waiting (shopping) 15 mins while they got stuff ready, I was completely blown away when they told me I owed $0. I was totally expecting to pay for this since I am on a high deductible health insurance plan (HSA compatible).

Luckily Costco had my insurance on file and checked for me while I was off shopping. I just assumed it would not be covered since I was under 60, as that is what happened to my husband 2 or 3 years ago.

Apparently BCBS has changed their policy!!! The pharmacist said he thought insurance companies had been under a lot of pressure since the FDA reduced the age for the vaccine to 50.

It would have cost $240.

There was a syringe and two vials (one with silver or white seal, one green), FWIW.

If we find out in 10 years that I need another one or some kind of booster - no prob.

I just called Blue Shield CA to see if I can get one for free and they said that I had to be 60 or over. Different here I guess.


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[eytonxav]

Got the vaccination several years ago, no pain afterwards and no shingles to date.

 

[audreyh1]

I just called Blue Shield CA to see if I can get one for free and they said that I had to be 60 or over. Different here I guess.


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Wow, bummer. I was very surprised.

 

[ERD50]

I got my shot today at Costco. I promised myself I would get it when I was 55 and my year is almost up!

After waiting (shopping) 15 mins while they got stuff ready, I was completely blown away when they told me I owed $0. ...

It didn't work that way for me (look back ~ 4 posts).

When I first called, they said I would need to wait for the EOB to show up in the system. I called a few weeks ago, after no EOB, and explained it all, and they said I need to submit as a Medical Claim, that it would be covered since they told me to go on that phone call. So I did that (they need the originals for everything, arggghhhh). I see today, it did show up, and says it needs to be processed by such and such dept, and will be denied if not ordered by my PCP. Well, I'm sure this will be another fight.

-ERD50

 

[Rustic23]

I ran into this, don't know how much of it is based on regulations, or 'They say'.

I have TriCare for life as my provider of drugs.

They say it has to be given by PCP. PCP said they don't give it, you get it at the drug store, or such. Tricare says if it is not given in the PCP office, they will not cover it. Waited about a year, and finally my PCP said they would give it. Turns our, as I take very few drugs, I did not meat the deductible, and paid most if not all the cost of the shot. Close to $200, I think. No real complaints considering what Medicare and Tricare covers.

 

[MBSC]

I ran into this, don't know how much of it is based on regulations, or 'They say'.

I have TriCare for life as my provider of drugs.

They say it has to be given by PCP. PCP said they don't give it, you get it at the drug store, or such. Tricare says if it is not given in the PCP office, they will not cover it. Waited about a year, and finally my PCP said they would give it. Turns our, as I take very few drugs, I did not meat the deductible, and paid most if not all the cost of the shot. Close to $200, I think. No real complaints considering what Medicare and Tricare covers.

TRICARE covers the shingles vaccine, Zostavax, for beneficiaries 60 and older. You can get the vaccine at a participating TRICARE network pharmacy or at your doctor’s office.

You can get the shingles vaccine for free at a participating network pharmacy.

If you want to get the shingles vaccine at your doctor’s office... if you're using TRICARE For Life, you'll pay: TRICARE's deductible and cost share.

Source: Is It Covered? - Shingles Vaccine

Also:

1) You may receive the shingles vaccine at no cost at a participating TRICARE retail network pharmacy. Be sure to call the pharmacy first to see if there are any restrictions.
2) You may receive the shingles vaccine from your doctor’s office. However, because Medicare does not cover the vaccine, TRICARE For Life (TFL) will be processing the claim as primary payer when received at a provider’s office. When TFL pays as primary, there is a $150.00 deductible and then a 25% cost-share (TFL will pay 75% of the allowed amount after the deductible has been met).

Source: Shingles and Tricare for life - Topic

 

[ziggy29]

Apparently BCBS has changed their policy!!! The pharmacist said he thought insurance companies had been under a lot of pressure since the FDA reduced the age for the vaccine to 50.

It would have cost $240.

Getting ready for open enrollment here, and I noticed that on my plan with a different insurance company, too -- shingles is now covered at age 50+ rather than 60+ as a preventative care benefit which is covered 100%, first-dollar.

Since I just turned 50 a couple weeks ago (koff koff), I suppose it's something I could do now if I decide the benefits outweigh the risks at my age.

 

[Nords]

Getting ready for open enrollment here, and I noticed that on my plan with a different insurance company, too -- shingles is now covered at age 50+ rather than 60+ as a preventative care benefit which is covered 100%, first-dollar.

Since I just turned 50 a couple weeks ago (koff koff), I suppose it's something I could do now if I decide the benefits outweigh the risks at my age.

The threshold was dropped to age 50 a few years ago. We got it as soon as we could.

Talk with people who've had shingles-- I suspect you'll conclude that the rewards are far better than the risks, and the pain is not worth it at all.

 

[MBAustin]

My primary doctor said I should get it but suggested I go to a walk-in clinic as it would be cheaper - she didn't think it would be covered so I'd have to pay full price as I haven't met my (high) deductible this year. I went to my favorite Minute Clinic in CVS and found out that the vaccine has to be kept frozen and not all CVSs have a freezer - if they do, the shot is given by the pharmacist, not the Minute Clinic. Very interesting. And they only keep a few doses on hand so she suggested calling in advance.

 

[Lakewood90712]

I'm the youngest and not yet 60 , older sister is also not 60 and her HMO will not pay, she works in a hospital, so maybe it's a good idea for her to pay out of pocket, and claim as an employee expense ?.

My mom swears I was the only one of her brood that did not get chicken pox. For some reason she is also quite sure I did not get the smallpox vax back when it was s.o.p. for school in the 1960's.

Would I be at risk getting chicken pox if I got the shingles vax , can I get tested to see if I already have chicken pox antibodies ?

One more thing , I am my mom's caregiver , she has a weak immune system. Would I be somehow be putting her at any risk if I got the shingles vax ?

 

[Alan]

I would check with your mother's physician if she should get the vaccination.

Shingles vaccine: Should I get it? - Mayo Clinic

The shingles vaccine isn't recommended if you:

• Have ever had an allergic reaction to gelatin, the antibiotic neomycin or any other component of the shingles vaccine
• Have a weakened immune system due to HIV/AIDS or another disease that affects the immune system
• Are receiving immune system-suppressing drugs or treatments, such as steroids, adalimumab (Humira), infliximab (Remicade), etanercept (Enbrel), radiation or chemotherapy
• Have cancer that affects the bone marrow or lymphatic system, such as leukemia or lymphoma
• Are pregnant or trying to become pregnant

Shingles is caused by the varicella-zoster virus — the same virus that causes chickenpox. After you've had chickenpox, the virus lies inactive in nerve tissue near your spinal cord and brain. Years later, the virus may reactivate as shingles.

 

[omni550]

Is there a way to test if you have had chicken pox?

An acquaintance of mine (age early 70s) claims he never had chicken pox and recently got shingles. His was on his torso. A few weeks later it is still quite painful (he says it feels like a bad sunburn that won't go away) whenever he is wearing clothing, walking or riding in a vehicle. He says he stays home a lot as a result and basically stays in the nude to reduce the pain.

omni

 

[Nunthewiser]

I already said it once on this thread, but unless you are eating cat food for dinner tonight, take it from me and Terry Bradshaw, get the vaccine. At first I thought I was passing a kidney stone, then it got worse. Never had such pain, and it lasted for weeks...

 

[O2Bfree]

An acquaintance of mine (age early 70s) claims he never had chicken pox and recently got shingles. His was on his torso. A few weeks later it is still quite painful (he says it feels like a bad sunburn that won't go away) whenever he is wearing clothing, walking or riding in a vehicle. He says he stays home a lot as a result and basically stays in the nude to reduce the pain.
omni

My mom had them back in February, 8+ months ago. They ran across her back and under her breast, and are still painful enough that she can't wear a bra. Unfortunately, she is well-endowed, and at 86 really needs one, so it's put a damper on her social life because there's only a few outfits she feels comfortable wearing in public.

 

[tmm99]

I'm the youngest and not yet 60 , older sister is also not 60 and her HMO will not pay, she works in a hospital, so maybe it's a good idea for her to pay out of pocket, and claim as an employee expense ?.



My mom swears I was the only one of her brood that did not get chicken pox. For some reason she is also quite sure I did not get the smallpox vax back when it was s.o.p. for school in the 1960's.



Would I be at risk getting chicken pox if I got the shingles vax , can I get tested to see if I already have chicken pox antibodies ?



One more thing , I am my mom's caregiver , she has a weak immune system. Would I be somehow be putting her at any risk if I got the shingles vax ?

Yes you can get tested for the antibody. I got the test done before I got the shingles vaccine. I told my doctor I wasn't sure if I had had chicken pox and she ordered the test for me.


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[swakyaby]

I called my insurance today, Blue Shield of California, to find out if the shingles vaccine is covered at my age of 54. First, I was gently criticized for not going to the explanation of benefits on their website first. Then she said the vaccine is 100% covered at age 60 when given by PCP. When I asked if that meant I would pay 100% out of pocket, she said no. She noted that I had already met my deductible for the year, and said that my cost is only 20% of the allowed amount. But that is only if I get the vaccine at my primary care doctor's office.

 

[ziggy29]

I called my insurance today, Blue Shield of California, to find out if the shingles vaccine is covered at my age of 54. First, I was gently criticized for not going to the explanation of benefits on their website first. Then she said the vaccine is 100% covered at age 60 when given by PCP. When I asked if that meant I would pay 100% out of pocket, she said no. She noted that I had already met my deductible for the year, and said that my cost is only 20% of the allowed amount. But that is only if I get the vaccine at my primary care doctor's office.

I think the change in FDA approval for shingles vaccine from 60+ to 50+ is recent. It's possible that it might change from 60 to 50 in some plans on January 1, since most (all?) ACA-compliant plans are following FDA guidelines for determining when vaccinations are treated as covered preventative care.

 

[audreyh1]

I think the change in FDA approval for shingles vaccine from 60+ to 50+ is recent. It's possible that it might change from 60 to 50 in some plans on January 1, since most (all?) ACA-compliant plans are following FDA guidelines for determining when vaccinations are treated as covered preventative care.

FDA announced the change to 50 years in March of 2011. So it's been over 4 years now.

 

[Gotadimple]

I called my insurance today, Blue Shield of California, to find out if the shingles vaccine is covered at my age of 54. First, I was gently criticized for not going to the explanation of benefits on their website first. Then she said the vaccine is 100% covered at age 60 when given by PCP. When I asked if that meant I would pay 100% out of pocket, she said no. She noted that I had already met my deductible for the year, and said that my cost is only 20% of the allowed amount. But that is only if I get the vaccine at my primary care doctor's office.

I think I'd call them again and if you get the same answer, ask to speak to a supervisor. If federal law has changed, they need to follow it, or tell you why they don't have to.

 

[tfudtuckerpucker]

According to the CDC, the shingles vaccine does not have a recommendation for ages 50-60. Or am I reading this incorrectly? Under what conditions should a doctor approve this for ages 50-60, so that it's covered under the ACA?

"Shingles vaccine is approved by FDA for people aged 50 years and older. However, CDC does not have a recommendation for routine use of shingles vaccine in people aged 50 through 59 years old. Adults aged 50 through 59 years who have questions about the shingles vaccine should discuss the risks and benefits with a health care provider. There are no long-term studies showing how long the vaccine is effective in 50 to 59 year olds. In adults vaccinated at age 60 years or older, protection from the vaccine decreases within the first 5 years after vaccination. "

 

[omni550]

I spoke with the (age 70-ish) acquaintance who just got shingles a few weeks ago. He had held off getting the shot due to the ~$250 cost plus he always thought he'd never get shingles.

He mentioned that he has since found out that Medicare covers all but $5 of the cost of the shingles shot for those on Medicare. Can someone confirm?

Also, now that he's had shingles and is dealing with the ongoing nerve pain, he said he'd pay $250 just to avoid the pain, fwiw.

omni