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Re: Will Medicare Pay for Shingrix?

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Message 31 of 37

You need to check with your individual Part D carrier.

The Humana plan considers Shingrix as Tier 4 shot

and the out of pocket is quite high.  Yes, it is covered

by Medicare, but, what do you have to pay? Articles

are misleading that say "Covered by Medicare Part D"

Check first before having the shot at a participating

pharmacy.  Don't go to your doctor to have it done. 

My understanding is that it has to be a participating

pharmacy for Part D coverage.    

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Re: Will Medicare Pay for Shingrix?

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Message 32 of 37

I too thought it should be covered by Medicare, but found out otherwise.  However, my cost is only $80 for both shots under my UPMC health plan, so there's obviously a wide variance in how much you're charged.

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Re: Will Medicare Pay for Shingrix?

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Message 33 of 37

@BarbaraShearer52wrote:

I think it should be covered along with other important immunizations in Medicare Part B.  We have Humana Part d and the cost is going to be $320 to receive both shots.  I don’t know how many people will be able to afford this.  In the end, the cost of immunizing people against shingles will be less for Medicare if it is covered. 


We may all want it to be covered by Part B but in order to keep down cost associated with Part B, it isn't.  Of course, those eligible low income seniors may get extra help for Medicare Part D.

 

Part B Medicare is paid for by premium payments from beneficiaries which represents about 25% of the programs cost, the other 75% of the cost of Part B Medicare is paid for out of taxpayers money from the General Fund.

 

The ONLY preventative care vaccines or immunizations covered by Medicare Part B are:

1.  Influenza: once per flu season 
2.  Pneumococcal: once per lifetime with high-risk booster after 5 years - covers both types of vaccines to cover as many varieties as possible
3.  Hepatitis B: for persons at intermediate- to high-risk

4.  TDaP  

 

These are the ones which have coverage when given in a doctor's office.

The others are covered by Medicare Part D and for coverage are given by a state licensed pharmacist.

 

Yes, this is done this way in order to save the government money one way or another - and Part B premium cost for beneficiaries.

 

In the overall coverage length, this is not an expensive vaccine especially since it doesn't have to be given every year.

 

Extra Help with Part D Medicare is available for those  beneficiaries with low income.

 

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Will Medicare Pay for Shingrix?

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Message 34 of 37

I think it should be covered along with other important immunizations in Medicare Part B.  We have Humana Part d and the cost is going to be $320 to receive both shots.  I don’t know how many people will be able to afford this.  In the end, the cost of immunizing people against shingles will be less for Medicare if it is covered. 

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Re: Will Medicare Pay for Shingrix?

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Message 35 of 37

@jimarleywrote:

Will Medicare pay for the new Shingles Shot---Shingrix?


As with the old one - it should be covered by your Medicare Part D plan, NOT Part B.

GoodRx gives an estimate of the cost depending upon which stage a person might be in in their Part D coverage and which plan/insurer they have. 

GoodRx - Shingrix Medicare Coverage

 

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Will Medicare Pay for Shingrix?

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Will Medicare Pay for Shingrix?

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Message 37 of 37

Will Medicare pay for the new Shingles Shot---Shingrix?

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