Medicare Part B & D, and Vaccinations?

[Telly]

I'm used to going to a pharmacy for vaccinations. Wondering if my joining Medicare very soon is going to change this...
I was looking through a Part D Formulary, saw ShingRx, did not see Flu Shot or Pneumonia Shot(s).

I've since learned a few things about "The Pneumonia Shot". It is really TWO shots, as recommended by the CDC. First shot at age 65 is PCV13 (Prevnar13 by Phizer), followed a year later by the second shot, PPSV23 (Pneumovax23 by Merck). GoodRX shows them in my area as $185 and $97 respectively, with coupon, but that does not cover the actual administration of the shot (may be some extra $).
Also saw that the Pneumonia shots are covered under Part B, not Part D. So that seems to say I would need a Drs. office visit, or maybe Minute Clinic or something like that. Or just pay cash myself and get it at a pharmacy. Which with a $183 deductible on my soon to start Part B with Plan G, may not be a big deal by itself, especially with them 1 year apart.

I don't know about Flu Shots. Maybe just do them in the pharmacy with cash.

Am wondering what you folks on Part B with supplement + Part D are doing, and which and where you get them, like at Doc, at walk-in clinic, at pharmacy? And if you get any of them outside of Medicare, by just paying cash.

 

[braumeister]

Not sure about the others, but my annual flu shot (normally done at the pharmacy) is covered by basic Medicare part B. No supplement involved.

 

[audreyh1]

I'm used to going to a pharmacy for vaccinations. Wondering if my joining Medicare very soon is going to change this...
I was looking through a Part D Formulary, saw ShingRx, did not see Flu Shot or Pneumonia Shot(s).

I've since learned a few things about "The Pneumonia Shot". It is really TWO shots, as recommended by the CDC. First shot at age 65 is PCV13 (Prevnar13 by Phizer), followed a year later by the second shot, PPSV23 (Pneumovax23 by Merck). GoodRX shows them in my area as $185 and $97 respectively, with coupon, but that does not cover the actual administration of the shot (may be some extra $).
Also saw that the Pneumonia shots are covered under Part B, not Part D. So that seems to say I would need a Drs. office visit, or maybe Minute Clinic or something like that. Or just pay cash myself and get it at a pharmacy. Which with a $183 deductible on my soon to start Part B with Plan G, may not be a big deal by itself, especially with them 1 year apart.

I don't know about Flu Shots. Maybe just do them in the pharmacy with cash.

Am wondering what you folks on Part B with supplement + Part D are doing, and which and where you get them, like at Doc, at walk-in clinic, at pharmacy? And if you get any of them outside of Medicare, by just paying cash.

Interesting - DH got pneumonia shots starting at age 60 on doctors strong recommendation. Don’t remember if they were covered - but probably were otherwise I would have remembered.

My (non Medicare) insurance is covering the old shingles vaccine even for 50+, but Shingrx is not in their list yet.

 

[MBSC]

Also saw that the Pneumonia shots are covered under Part B, not Part D. So that seems to say I would need a Drs. office visit, or maybe Minute Clinic or something like that.

You can still get the shots at the pharmacy. The "Parts" refer to the funding source, not where the medical service is received.

For example, the free-to-you flu shot at the pharmacy is funded by Part B which is technically the "Supplemental Medical Insurance trust fund".

Or just pay cash myself and get it at a pharmacy. Which with a $183 deductible on my soon to start Part B with Plan G, may not be a big deal by itself, especially with them 1 year apart.

The two Pneumonia shots are covered under the preventive benefit with no cost sharing to the Medicare enrollee even without Medigap coverage.

 

[NoMoreJob]

I had both the Shingles and flu vaccinations recently.

My Shingles shots (2) were covered by my Part D drug plan. However, I don't take any maintenance drug and have a $405 deductible so I ended up paying for them out-of-pocket - a total of $320 at WalMart I've probably just about met my deductible now. :-/

My flu shot was covered in full under Part B.

I have no idea what the logic is (if there is any).

BTW, if you have to pay for the Shingles shots out-of-pocket be careful of how prices are quoted. Both my doctor and our local grocery store pharmacy quoted $160+/- for each shot but upon further questioning also charge a $30 'administration fee' per shot. WalMart charges $160 per shot but that is the full charge, there are no additional fees.

 

[Luvdogs]

My husband and I both got the Shingrix shots (first shot) a couple of weeks ago. He has Medicare Plan F (the most comprehensive) and it cost him $160 because it is handled under the prescription part not the medical part.

Shingrix is Tier 4 so he had to pay toward the deductible. I presume the 2nd shot will be the same.

I have BCBS from employer retiree. I went to Sam's and they said they could do the flu shot and Shingrix at the same time. Total cost for me --zero.

You just never know how much anything is going to cost.

 

[Telly]

You can still get the shots at the pharmacy. The "Parts" refer to the funding source, not where the medical service is received.

For example, the free-to-you flu shot at the pharmacy is funded by Part B which is technically the "Supplemental Medical Insurance trust fund".
The two Pneumonia shots are covered under the preventive benefit with no cost sharing to the Medicare enrollee even without Medigap coverage.

OK, thanks for all the info! I had never hovered over the button marked "What Medicare Covers" on Medicare.gov to see and select "Preventive and Screening Services" and then scroll down to see "Shots". Duh!
So Part B covers Hep B for mid and high risk people (not me), Flu shots (once per year), and the Pneumonia shots, second one year (or more) later, all at:

You pay nothing for XXXX shots if your doctor or other qualified health care provider accepts assignment.

I had not considered before that a pharmacy would be included for anything Part B. I was hung up on the concept that Part B meant method/place of delivery. I was (gladly!) wrong! And NoMoreJob and braumeister have nicely tried it out for me in advance on the Flu shots

So of the shots that are known to me at this time that I will be getting on Medicare, only one type, ShingRix, will I have to use Part D. Around here, ShingRix is unobtainable, I will run out of time looking before Medicare starts for me. Will get Flu shot for this season on existing insurance before it ends in the switchover. My Part D will have a $405 deductible, so most likely I will be paying 100% out of pocket for ShingRix pair, so when available here, I'll check out cash with GoodRX or other coupon vs. using my Part D plan.

 

[candrew]

My (non Medicare) insurance is covering the old shingles vaccine even for 50+, but Shingrx is not in their list yet.

Interesting about your non-Medicare insurance covering the old shingles vaccine ≧50 years-of-age. As of 3 years ago, my previous empl*yer's health plan excluded that coverage for anyone younger than 60.

 

[audreyh1]

Interesting about your non-Medicare insurance covering the old shingles vaccine ≧50 years-of-age. As of 3 years ago, my previous empl*yer's health plan excluded that coverage for anyone younger than 60.

I was surprised because when DH got the shot two years prior, he was not covered. So sometime in those 2 years they dropped the requirement to 50 years of age - still way after the new guidelines.