New Shingrx Shingles Vaccine

[foxfirev5]

Does the ACA cover Shingrx as part of the drug plan? If so you may be able to get your shots at a local pharmacy (if in network for your plan).

Rita

I tried that route with a flu shot and my provider denied the claim. But I'll check it out thanks

 

[CDRE]

Here is one example of a Plan under ACA that covers Shingrx:

....Preventive care services include screenings and other services for adults and children. All recommended
preventive services will be covered as required by the Affordable Care Act (ACA) and applicable State
law. This means many preventive care services are covered with no Deductible, Copayments or
Coinsurance when You use an in-network Provider.....

....Immunizations for children, adolescents, and adults recommended by the Advisory Committee on
Immunization Practices of the Centers for Disease Control and Prevention;....


Then here's the List:
https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html

 

[Sunset]

Because health care insurance companies are so crazy with the rules, I often phone them to see if something is covered.

For example I phoned them and asked if Shingrix was covered if I went to a pharmacy, they said no, only at my doc.
Very annoying...

 

[CardsFan]

I went though this last year, as DW and I were approaching Medicare.

What I found was that MOST pre-Medicare plans cover the Shingrx vaccine under medical, not drugs. I know mine did (retiree medical, not ACA). BUT, that does not mean you need to go to a doctor, it just needs to be coded correctly, or you need to pay the pharmacy and be reimbursed. First shot for DW, we had to submit. Second shot for her, and both of mine, Walgreen's was able to code it and get direct payment. No out of pocket costs.

I also found that MOST Medi-Gap plans cover it under part D (drugs). That would make it subject to any deductible you might have. So, if you are under a Plan F or G, with a part D supplement, you may need to pay out of pocket.

I did not look at Advantage Plans, as that was not in the future for us.

 

[H2ODude]

I checked (after making the post about the v not being available for two years) and turns out Walmart, Walgreens, and CVS all have it now. Runs 168-179 a shot. There seem to be Good RX coupons for $20 buy none I called accept them. We're going to go get. Pay that amount (twice) to avoid what I've seen described? Sure thing. Our cheapo Humana D ($10 a month) won't pay anything but that's OK. I don't think the more expensive Humana plan we had been on (~$35 a month) last year paid anything either.

 

[Sunset]

I got my shingrix shot and pneumonia shot at the doctors, as that is where my insurance will cover it.
My shingrix arm was tender for 2 days, but otherwise no other reaction

In 3 months I go back, for a nurse appt to get the other shot, and a flu shot. Not sure if copay is required for that or not as only seeing a nurse

All these complex rules...

 

[ivinsfan]

I got my shingrix shot and pneumonia shot at the doctors, as that is where my insurance will cover it.
My shingrix arm was tender for 2 days, but otherwise no other reaction

In 3 months I go back, for a nurse appt to get the other shot, and a flu shot. Not sure if copay is required for that or not as only seeing a nurse

All these complex rules...

Well at our large medical clinic they quit giving the Shingrix shot because they said people would get the shot at the clinic and then their insurance wouldn't pay for it, so the clinic tells everyone to go to a retail pharmacy.

 

[Time2]

Because health care insurance companies are so crazy with the rules, I often phone them to see if something is covered.

For example I phoned them and asked if Shingrix was covered if I went to a pharmacy, they said no, only at my doc.
Very annoying...

I called my Part D insurance co, and ask about a shingles vacine, they said it's not covered, then I see in their coverage book that Zostavax is covered, (35%). I discussed it with Boomer Benefits and they called my Part D and was told that Shingrix is covered (35%).
I'll do it soon, but I'm still not sure I'll get coverage. My part D premium is only $140 a year, it would take a year for them to recoup their expense.

 

[calmloki]

I got shot 2 in the Shingrix series a week ago - could sure tell where I got the shot for six days. Looks like it is not a lifetime immunization, which I didn't realize, and works by boosting the immune system in the aged? Makes me wonder how specific that immune system boost is and whether the Shingrix will help protect against a wide range of virus types. Better than drinking bleach as a Covid preventative?

 

[Time2]

Better than drinking bleach as a Covid preventative?

"The dose makes the poison"

 

[GravitySucks]

Finally went to get shot number 1.
Pharmacist didn't know if the government tracking nanobots are in the first or second shot though.[emoji2]

 

[Chuckanut]

Well at our large medical clinic they quit giving the Shingrix shot because they said people would get the shot at the clinic and then their insurance wouldn't pay for it, so the clinic tells everyone to go to a retail pharmacy.

My doctor is now part of a nationwide big medical clinic company. They are slowly phasing out giving shots. According to him, not enough people get the shot at the clinic so they have to throw out expensive vaccines and such. They recommend the pharmacy for routine shots.

We are going the way of Italy where the pharmacy is the first line of defense against the day-to-day minor illnesses that bother us from time to time. When I bashed my big toe in Firenze, it turned very swollen, red and appeared to be in the very early stages of an infection. The local pharmacists took a look at it, and sold me a antibiotic cream that was very effective. He also asked if I wanted the antibiotic pills. No Rx was needed. I refused the pills knowing I could get them in a few days with no hassle at any pharmacy in Italy. Here in the USA they would have required a doctor visit.

 

[Katsmeow]

I just picked up on this thread, I'm on Medicare, dissappointed it's not covered.
Checked on my plan D, they said my cost would be $159.48. I quizzed the rep, and I don't think they pay anything.
I can get the shots for $155 each with GoodRx.

I'm looking at my Humana part D coverage and it says they don't cover it.
I see on the Boomer Benifits page this, "Yes, Medicare does cover the shingles vaccine, but not under Original Medicare Parts A and B. Instead, it is your Medicare Part D plan that is required to provide coverage for the shingles vaccines."
On Monday I will call Boomer and ask about this. I suspect they don't cover it, since the cost of the two shingrix shots would be 2 years of my part D premiums.

I called my Part D insurance co, and ask about a shingles vacine, they said it's not covered, then I see in their coverage book that Zostavax is covered, (35%). I discussed it with Boomer Benefits and they called my Part D and was told that Shingrix is covered (35%).
I'll do it soon, but I'm still not sure I'll get coverage. My part D premium is only $140 a year, it would take a year for them to recoup their expense.

As I think it is. Vaccinations like this are covered under Part D. The specific Part D policy though might or might not cover it (I think?). However, different Part D policies have different deductibles.

Most of the cheap Part D policies use the standard deductible of $435 which is the maximum. So for most people if 2 Shingrx shots are a total of say $400 then even if the carrier covers it they won't may anything if you haven't eroded the deductible some other way. For people who use up their deductible each year then this is not an issue.

I take one prescription that costs me nothing and is not subject to the deductible. Rarely do I have a prescription which eats into the deductible. I think I may go do this after the first of the year. It will help to erode the deductible early in the year in case I do have something later in the year where I might need to take a prescription.

 

[sengsational]

I read somewhere that you really don't want to have a shingles flare in this day and age, as it really beats down your immune system. And you want your immune system as sharp as it can be in order to start the battle against Sarscov2, should any of those bad-boys show up on the scene.


Just to be clear, this suggests getting vaccinated against shingles is a good idea. I've had "the old one", but plan on Shingrix shortly.

 

[Honeyfill]

Got the first shot today. So far so good. No side effects. 2-6 months before I can take the second one.

 

[Gumby]

For a long time, I resisted the idea of a shingles vaccine, since I never had chicken pox when I was young. I finally had a long conversation with my doctor at my annual checkup two weeks ago. He told me the following:

1. Even if you think you never had chicken pox, you may have had an asymptomatic case. Since my brother and sister had chicken pox, it is likely that I had it too and just never suffered the traditional symptoms.

2. Even if you never had chicken pox, you can't get it from the shingles vaccine. In fact, the shingles vaccine is actually like a super strong chicken pox vaccine. So if you really never did have chicken pox, you will forever be immune to it after you get a shingles vaccine.

3. In response to my question - given the above, there is little point in testing to confirm that you have never been exposed to chicken pox (because you do not have chicken pox antibodies) and then giving you the normal chicken pox vaccine.

I found his argument convincing, so I got the first shingles shot ten days ago. So far, so good.

 

[audreyh1]

We are going the way of Italy where the pharmacy is the first line of defense against the day-to-day minor illnesses that bother us from time to time. When I bashed my big toe in Firenze, it turned very swollen, red and appeared to be in the very early stages of an infection. The local pharmacists took a look at it, and sold me a antibiotic cream that was very effective. He also asked if I wanted the antibiotic pills. No Rx was needed. I refused the pills knowing I could get them in a few days with no hassle at any pharmacy in Italy. Here in the USA they would have required a doctor visit.

That would be nice. Sudden health care needs - we’re able to go to the doctor’s office immediately, but it will be a nurse practitioner that see us and prescribes meds if needed. Even on Saturday. Works pretty well, actually. We usually call and can get same day appointment.

 

[audreyh1]

For a long time, I resisted the idea of a shingles vaccine, since I never had chicken pox when I was young. I finally had a long conversation with my doctor at my annual checkup two weeks ago. He told me the following:

1. Even if you think you never had chicken pox, you may have had an asymptomatic case. Since my brother and sister had chicken pox, it is likely that I had it too and just never suffered the traditional symptoms.

2. Even if you never had chicken pox, you can't get it from the shingles vaccine. In fact, the shingles vaccine is actually like a super strong chicken pox vaccine. So if you really never did have chicken pox, you will forever be immune to it after you get a shingles vaccine.

3. In response to my question - given the above, there is little point in testing to confirm that you have never been exposed to chicken pox (because you do not have chicken pox antibodies) and then giving you the normal chicken pox vaccine.

I found his argument convincing, so I got the first shingles shot ten days ago. So far, so good.

DF was convinced he had never had chicken pox. But he broke out in shingles at age 84! Fortunately, even though he didn’t know what the rash was, he got himself to an emergency room right away and was diagnosed and treated. Mild brief case. Lucky! Us kids were horrified.

DF’s doctor told him he was probably asymptomatic when he caught chicken pox.

 

[RunningBum]

We are going the way of Italy where the pharmacy is the first line of defense against the day-to-day minor illnesses that bother us from time to time. When I bashed my big toe in Firenze, it turned very swollen, red and appeared to be in the very early stages of an infection. The local pharmacists took a look at it, and sold me a antibiotic cream that was very effective. He also asked if I wanted the antibiotic pills. No Rx was needed. I refused the pills knowing I could get them in a few days with no hassle at any pharmacy in Italy. Here in the USA they would have required a doctor visit.

I wonder if Italy has any problems with too many people taking antibiotics when for stuff like the flu, when they are of no value. This just adds to germ resistance for no benefit.

 

[bjorn2bwild]

Finally got the first shot - oh boy that was a long needle. Arm was sore for about a half day.
Our BCBS EPO plan had us in a bit of a catch 22. The vaccine is fully covered through a preferred provider, only none of them were actively administering it. On a tip, DW found a clinic that gave the shot on a limited basis.
The way it works is you call to see if they have it, fill out the info on their website, then they call back within an hour to set up an appointment. When you arrive, you stay in the vehicle and call, they prepare the shot then come and get you when it is ready. They took us both in at the same time, very efficient.

 

[Bongleur]

Got mine on Thur. Was a bit sore in the evening, like a charlie horse. No big deal. Today still a red patch, and a little sore if I press on it. All in all not bothering me.

 

[tuckeverlasting]

I got my first Shingrix shot last month at the local Kroger pharmacy. I had the old shingles shot about 7 years ago. Waited to get the new one until the supply seemed ample. No side effects to speak of other than mild arm soreness, a mild headache and slight stomach upset.

 

[MBAustin]

I went to CVS today for my flu shot and asked if they had the Shingrix also and they did! So I got stuck in both arms. The Shingrix arm is definitely sore.

 

[gerntz]

DW "finally" got her first shot today with me being done 2+ years ago. Asked her "why now" & she said between this, flu shot, likely virus vaccine, & 2nd one of these, that she'd better get started. Glad something got her into action.

 

[ohiodep]

Got my Shingrix vaccine on Wednesday at my local Sam's Club pharmacy (flu shot as well). Injection site was sore and I spiked a fever later that day. Tough time sleeping that night and was wiped out all day Thursday.

I previously had a mild shingles case at age 48 and definitely want to do what I can to prevent a reoccurrence.

I do find it interesting that more than a few of my co workers younger than the recommended vaccination age of 50 have already had a case of shingles. Maybe the recommended age should be lowered?