Will Medicare Pay For Shingles Vaccine?

Does Medicare cover shingles vaccine? Will my Medigap plan pay for Shingrix? Can I get the shot for free during my Medicare Annual Exam?

GA Medicare expert Bob Vineyard answers your immunization questions.

Does Medicare Pay for Shingles Vaccine
Will Medicare Pay for Shingles Vaccine?

What is Shingles?

Shingles is a painful, blistering skin rash caused by the varicella-zoster virus. The same virus that causes chicken pox is also responsible for shingles.

After having chicken pox, the virus can lay dormant in your body for years. The virus lives in your nervous system near your spinal cord.

According to Mayo Clinic:

The signs and symptoms of shingles usually affect only a small section of one side of your body. These signs and symptoms may include:

  • Pain, burning, numbness or tingling
  • Sensitivity to touch
  • A red rash that begins a few days after the pain
  • Fluid-filled blisters that break open and crust over
  • Itching
Will Medicare Pay for Shingrix?

What is the Shingles Vaccine and How Does it Work?

Most vaccines start with some form of the virus which is injected. The idea is your body will detect the intruder and generate anti-bodies to attack the virus.

Older vaccines such as Zostavax use a weakened form of the virus. Shingrix, approved in 2017, uses inactivated (dead) virus. Vaccines containing dead virus cells eliminates the risk of transmission.

Is Shingrix Better than Zostavax?

Currently there are only three approved shingles vaccines. Zostavax, Shingrix and Varivax.

Zostavax, approved in 2006, was the only vaccine for shingles for many years.

Shingrix gained approval as a vaccine in 2017 and is considered to be 97% effective in adults age 50 to 69. Whereas Zostavax has a 50% effectiveness rate.

Varivax was approved in 2018. It is similar in price and effectiveness to Shingrix.

All three named shingles vaccines are approved by Medicare and should be included in all Medicare Part D plans.

How Much Does the Vaccine Cost?

Cash prices for Shingrix are currently $150 per dose. You need two doses for maximum effectiveness. Your second does should be given at least 2 months but no more than 6 months following your first dose.

Zostavax is a single dose immunization with a cash price of $225.

The cash price for Varivax is $150 per dose. The manufacturer recommends two doses a month apart.

How Long Before I Need to be Vaccinated Again?

Shingles vaccinations should remain effective for several years before you need another vaccination.

You can get Shingrix at age 50, when your chance of having shingles rises. Studies have shown that its protection remains strong for at least 4 years, but researchers hope it will last much longer because the immune response is stronger. – WebMD

Is the Shingles Vaccine Covered by Medicare?

Medicare covers the shingles vaccine as one of its preventive benefits. But, unlike some other vaccines that are paid through Part B, the shingles vaccine is covered by Part D.

Have You Had Shingles?

If you have chicken pox as a child? If you did you have a one in three chance of getting shingles as an adult.

Two years ago during my annual Medicare wellness visit my doctor asked if I wanted to get the shingles vaccination. We discussed the pro’s and con’s. She wrote a prescription for Shingrix.

I had every intention of getting the shot but all the local pharmacy’s were out of stock. They had no idea when they would have it in stock.

Two months later I woke up with intense itching and moderate pain. It started near my kidney and radiated around my left side.

My wife looked at it and said I had the Shingles.

Welcome to old age.

This was a weekend and my regular doctor was not available. On Sunday I went to a nearby urgent care facility. The doctor confirmed I had shingles.

I was given a prescription for the generic form of Valtrex.

Valacyclovir (Valtrex) is an antiviral medicine. It is used to treat or prevent infections caused by certain kinds of viruses. Examples of these infections include herpes and shingles.This medicine will not cure herpes. It is more popular than comparable drugs. It is available in generic and brand versions. Generic valacyclovir is covered by most Medicare and insurance plans, but some pharmacy coupons or cash prices may be lower. –GoodRx

Using Part D the prescription would have cost nearly $50. Using the coupon and paying cash my cost was $9.

Pay Cash or Use Your Drug Plan?

If you use your Medicare Part D plan for generic drugs you will almost always pay more. Buying generics and paying cash will normally save money.

The approved Shingles vaccines are all brand names. There are no generics. But you may still save money using coupons or drug assistance programs. Check the Medicare site for Patient Assistance Programs.

Do you have Medicare questions? Call or email.

#ShinglesVaccine #Shingrix #GAMedicareExpert

Medicare Cancer Drugs Are Costly

Medicare cancer drugs are about to become more costly because of proposed changes in the way they are covered. CMS wants to “save money” by moving Part B drugs to Part D. GA Medicare expert Bob Vineyard breaks it down for you.

Medicare cancer drugs
Medicare Cancer Drugs Becoming More Expensive

Not only cancer drugs, but medications for rheumatoid arthritis, macular degeneration and osteoporosis. DME drugs such as insulin may become ineligible for Medicare Part B reimbursement.

Medicare Cancer Drugs Becoming More Expensive

Saving Medicare – Sort of . . .

Medicare Advantage plans are now able to make changes in the way expensive, injectable drugs are covered. Drugs administered in a clinical setting will be subject to scrutiny.

Medicare Advantage plans will be REQUIRED to try cheaper drugs which may not be as effective as cancer drugs administered in a clinical setting.

These Advantage plans will be encouraged to employ step therapy to “reduce costs and improve outcome”.

Reducing costs means saving money spent by Medicare and the insurance carrier.

Not saving YOU money.

Note, this is only a test. Using Medicare Advantage patients as guinea pigs to see if lower cost drugs result in similar outcomes as more expensive protocols. Do you really want to be a test model?

If the test works cancer drugs will be shifted away from Part B coverage to Part D. This means you, the patient, will pay MORE for your medication.

Treating Cancer is Expensive

Years ago most treatment involved extensive surgery, radiation and chemo. Most of the treatment was as a hospital inpatient.

Now cancer, like most other medical conditions, is treated on an outpatient basis.

If you have original Medicare and a supplement plan your out of pocket costs are minimal. Often less than $500 per year for health care.

Drugs are a different story . . . unless you are receiving treatment under Medicare Part B.

Also, outpatient self administered drugs are subject to copay’s or coinsurance. It doesn’t matter if you have an Advantage plan or stand alone PDP. Your cost is the same.

Cancer forces 42% of patients to exhaust life savings in 2 years. The average patient saw a loss of $92,098. Bankruptcy occurred in 38.2 percent after four or more years. – Becker Hospital Review

Finding and Choosing the Right Plan

Turning 65 many get confused about the various health insurance options. Some ask friends or relatives. Others attend seminars. And there is all the mail that arrives every day before you are Medicare eligible.

Part D is the most confusing component of Medicare.

If you or a family member have experienced cancer you know about the cost of prescription drugs.

You need help, but not from just anyone. Consider talking with an expert. A GA Medicare expert . . .

Give me 10 minutes by phone to answer your questions. Ask me anything about Medicare. Anything at all.

Either you like what you hear or you don’t. If you don’t feel I can help you then we part as friends. No hard feelings. It’s not personal, just business.

But if you want and need my help I am ready to guide you through the Medicare maze. We move forward at your pace, not mine.

All I ask is an opportunity to EARN your business.

When you allow me to be your agent you have unfettered access any time. Call or email.

And there is never any charge.

This is my offer you can’t refuse.

What is the Pharmacy Gag Rule?

What is the pharmacy gag rule and why should I care? Is it because the medicine has a bad taste? Does the gag rule affect my Medicare Part D coverage? GA Medicare expert Bob Vineyard answers your questions.

pharmacy gag rule
What is the Pharmacy Gag Rule?

The pharmacy gag rule existed in a handful of states prior to October, 2018. It works like this.

You take a prescription to your pharmacy. If you ask the druggist about a lower price he/she was prohibited from telling you how to save money where the gag rule was in place.

The result, you pay more for your medication when you use insurance.

What is the Pharmacy Gag Rule?

How Does the Gag Rule Affect Me?

Essentially you pay more for your drugs than you should.

A recent study by JAMA indicates people with Medicare Part D drug insurance overpaid for prescriptions by $135 million in 2013. Copayments in those plans were higher than the cash price for nearly 1 in 4 drugs purchased in 2013. For 12 of the 20 most commonly prescribed drugs, patients overpaid by more than 33 percent.KHN

That’s more than just sofa change. Seniors on a fixed income need to hang on to as much of their money as possible.

Some folks, like Steve Knievel, considers $135 million “falling short of where it needs to be”

As a nation we spend $450 million on prescription medications. I think cutting costs by 25% to be significant.

Good News – Bad News

First the good news.

People on Medicare can see the impact of the pharmacy gag rule next year. As of January 1, 2020 a senior on Medicare is entitled to know if they can get their drugs for less by paying cash.

Pharmacists are allowed to tell you how to save money without using your Part D card.

Now the bad news.

Just because a druggist CAN tell you about lower prices does not mean they WILL tell you.

If you want to save money you will have to ask . . .

You can also save money by checking out Free and Low Cost Prescription Drugs.

But if You Like Paying Too Much . . .

You can always use your Part D plan.

GA Medicare expert Bob Vineyard has over 500 clients in Georgia. He specializes in explaining how to save money on prescription medications.

There is no pharmacy gag rule that can keep him quiet.

Georgia Medicare Plans YouTube Channel has several videos explaining how Medicare Part D works. Here are just a few things you can learn.

  • Choose a Part D plan that has a deductible
  • Use preferred pharmacy’s
  • Ask your doctor about generic alternatives
  • Pay cash for generic drugs
  • Use a discount card like GoodRx for generics
  • Consider buying brand names by mail from Canada

Every year we review our clients current drug plan and compare it to the new plans for the following year. Almost every time our clients will save money. An average of $60 per month.

Two years ago we saved one client over $600 per month and another over $700 per month.

A few weeks ago we showed a client how to cut his prescription eye medications from $800 to less than $250.

Let’s face it. Medicare Part D is confusing. But it doesn’t have to be.

How much can you save?

The pharmacy gag rule never kept us from telling our Medicare supplement clients how to save money.

Medicare Part D is Confusing

Medicare Part D is confusing to me. Why is that? What makes it so hard to understand? What is the donut hole? I thought it was going away. What’s wrong with picking the plan with the lowest premium . . . as long as it doesn’t have a deductible? And why do some plans have a deductible? How does it work? Do I pay the deductible BEFORE I have copay’s?

Medicare Part D is Confusing

Can anyone explain how Medicare drug plans work?

GA Medicare expert Bob Vineyard can help.

Why is Part D so Confusing?

Why is Medicare Part D so confusing. The Medicare drug coverage is designed by folks in Congress who will never use the plan. Part D is administered by insurance carriers.

What could possibly go wrong?

When you search for the phrase “Medicare Part D confusing” there are 107 million results. Congratulations! You are not the only one who is confused by Medicare drug plans.

Medicare Part D is Confusing

What if I Can’t Afford My Drugs?

Medicare Part D (Medicare prescription drug coverage) helps cover the cost of prescription drugs. If you have limited resources and income you may be able to get Extra Help. Monthly premiums, annual deductibles, and prescription co-payments — related to a Medicare prescription drug plan.

To qualify for Extra Help you must meet the resources and income requirement. You must also live in the United States.

In some cases you might qualify for a PAP (Patient Assistance Program).

Yes, Medicare Part D is confusing but there is plenty of help. You just need to know who to ask. Consider the folks at Georgia Cares as an example.

Medicare Late Enrollment Penalties

Did you know you can be penalized for failure to enroll in a Medicare drug plan on a timely basis?

The late enrollment penalty is an amount added to your Medicare Part D monthly premium.

You may owe a late enrollment penalty if you lack creditable coverage for 63 days or more after your Initial Enrollment Period is over, you go without:

  • Creditable drug coverage
  • Medicare Part D plan
  • Medicare Advantage plan that includes drug coverage
  • Other coverage such as employer group health plan

Also the LEP depends on how long you went without creditable coverage.

Your penalty is determined by multiplying 1% of the “national base beneficiary premium” ($33.19 in 2019) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.

The penalty you will pay is based on a formula so it could increase from year to year. It is also payable for life.

Medicare Part D is confusing. GA Medicare expert Bob Vineyard can help.

Part D Deductible

The majority of Medicare drug plans include a deductible. In most cases the deductible applies to tier 3 or higher drugs. The deductible can also be avoided by using mail order or filling your med’s at a preferred pharmacy.

Most people do not understand how the deductible works so they focus on plans without a deductible.

Many agents also do the same. Rather than explaining how a Part D deductible works they only sell plans without a deductible.

In most cases no deductible plans have higher premiums AND higher copay’s.

If you want to learn more about Medicare Part D plan deductibles, this video will help.

Using the Medicare Drug Plan Finder

Why is Medicare Part D confusing? If it was easy you wouldn’t need me.

New to Medicare – What Do I Need to Know?

When you are new to Medicare you will have questions. But you probably don’t know who can help. Even if you did, what questions will you ask?

You don’t know what you don’t know.

new to medicare
New to Medicare – What Questions to Ask?

About the time you think you have it all figured out they change the rules.

Turning 65?

If you are turning 65 and new to Medicare you are about to enter the state of confusion.

Medicare may SEEM simple, but it is not. It is easy until you have a claim. Then it becomes complicated. Where will you turn then? Will you go to the friend that told you to buy the plan they have? Maybe you will call the agent that SOLD you the plan? Good luck with that. They may not even be in the business by now.

You could call the carrier where you went direct to avoid talking to agents. You call an 800 number, press 1 for English then get routed to voice mail. Someone will call you back in a few days while you are in the shower.

How well does that work for you?

Maybe your best choice is to find a GA Medicare expert.

New to Medicare?

Enrolling in Medicare

If you are approaching age 65 and new to Medicare you know the drill. For the last year your phone has been ringing. Pushy insurance agents calling to SELL you a plan you don’t want, you don’t need and can’t afford.

Your mailman hates you because of all the junk mail that arrives at your door every day.

What do you keep? What do you throw away? Where do you turn for answers to your Medicare questions? Check out Medicare plans in Georgia.

Who Can Help Me?

There is nothing wrong with buying a Medicare plan online as long as you are prepared for a LOT of phone calls from agents wanting to SELL you something you don’t need, don’t want and can’t afford.

When you are new to Medicare how do you find the RIGHT plan?

All I ask is for you to give me 10 minutes by phone. Time to answer YOUR questions. You will NEVER be pressured to buy anything. This is your opportunity to ask ANY Medicare related question, then decide if you want to work with me or not.

It’s that simple.

It’s an offer you can’t refuse.