Shingrix Vaccine Not Covered by Medicare?

[Qs Laptop]

I understand that the Shingrix vaccine is not covered by Medicare part A or B, but might be covered by Part D. My doctor has recommended the vaccine and I plan on taking it. I understand it's a two-part vaccine with the shots 60-90 days apart.

My situation is I'm starting Medicare on Jan. 1st. I'm on Plan N. Currently I am on my wife's company's health care plan. Questions:

1. Is Shingrix vaccine covered under Medicare? If it might be covered under Part D, how do I find out? (I just got my Medicare card a couple days ago.) My Part D component is a minimal plan as I'm only on one generic medication.

2. Should I get the first part of the vaccine now under my wife's plan and get the second part when I'm on Medicare?

3. Should I wait a month until I'm on Medicare to get the complete vaccine sequence?

 

[Sunset]

If your current coverage pays for it, then get the first shot now. Saves you $150.

Then on medicare get the second shot, some part D will cover it. At worst it will be ~$150 for the second shot, and that is less than your deductible anyhow.

 

[badatmath]

https://www.humana.com/medicare/medicare-resources/shingles-shot

According to that it will be fully covered in 2023 if I read it correctly.

I found another article that said essentially that it was part of the "Inflation Reduction Act".

 

[euro]

If your current coverage pays for it, then get the first shot now. Saves you $150.

Then on medicare get the second shot, some part D will cover it. At worst it will be ~$150 for the second shot, and that is less than your deductible anyhow.

This is definitely how I would approach it too. Based on what I have seen during my recent Medicare research, I think there is a very good chance that Shingles vaccine will be covered.
In any event, as someone who has lived through Shingles, I would advise you to get the vaccine even if you have to pay it ALL yourself - yes, it's THAT painful!

 

[Northforker]

Both my wife and I got the shingrix vaccine in fall 2021 and early 2022, it was 100% covered by our Anthem BCBS ACA insurance. We got the shots at CVS. Our Covid vaccines and booster and our flu shots were also 100% covered. It seems silly for insurance not to cover reasonable preventive healthcare treatments that save them money in the long run.

 

[CRLLS]

https://www.humana.com/medicare/medicare-resources/shingles-shot

According to that it will be fully covered in 2023 if I read it correctly.

I found another article that said essentially that it was part of the "Inflation Reduction Act".

From what I understand, not only is it fully covered by Part D starting Jan 2023, but deductible does not have to be met either. Don't count on my sayso. Check your 2023 Part D coverage docs.

 

[Qs Laptop]

Found this on BoomerBenefits:

Medicare requires all Part D plans to cover the shingles vaccine. However, since Part D plans have networks, you’ll want to be sure you get the vaccine at a pharmacy in the plan’s network. Do not get the shingles vaccine at your doctor’s office. Doctor’s offices don’t have the ability to bill Part D plans. Therefore, getting the vaccine at your doctor’s office could result in you paying the entire bill and having to submit a reimbursement request to your plan.

There are several vaccines covered by Medicare Part D, including shingles vaccines. Remember, your Medicare Part B does not cover the shingles vaccine. However, you can find Zostavax and Shingrix on your Part D plan formulary. Check your Part D drug formulary to see which tier the vaccine falls into. Many plans put the vaccine into a Tier 3 category.

According to Clever Rx, Shingrix retails for around $155 per shot. You need two rounds of the shot when getting this shingles vaccine. Zostavax is slightly more expensive, retailing for anywhere between $212 and $240 per shot.

The Shingles vaccine is covered 100% by Medicare Part D starting in January 2023, regardless if you’ve met the Part D deductible.

https://boomerbenefits.com/faq/does-medicare-cover-the-shingles-vaccine/

 

[audreyh1]

Hasn’t Zostavax been phased out?

 

[euro]

Hasn’t Zostavax been phased out?

I don't think so, at least not in all markets. However, Shingrix is so much superior that it doesn't make sense to use Zostavax in all but the most unusual circumstances. For what its worth, I got Zostavax back in the day before Shingrix came out and decided to double down with Shingrix anyway. Much broader coverage/better efficacy (like: 98% vs 50%)

Edit: as it turns out, Zostavax WAS indeed pulled from the US market in 2020, as Audreyh pointed out. Interestingly, it looks like it received approval in Europe in 2022 - I assume this means Shingrix is not yet available in Europe. That is not unusual, new (and often better) treatments do tend to be available first in the US. That is one of the perks we get for footing higher drug bills.

 

[audreyh1]

I also had Zostavax first, a few years before Shingrix was available. I waited a couple more years until Shingrix was covered by my insurance.