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 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.

Medicare Drug Plan Finder
Using the Medicare Drug Plan Finder

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

Am I Required to Buy a Medicare Drug Plan?

Am I required to buy a Medicare drug plan? What if I don’t take drugs? Can I wait until I need a plan? GA Medicare expert Bob Vineyard explains.

Is Medicare Part D required by law? What is the best 2019 drug plan? Is there a penalty if I DON’T buy a prescription plan? Is Part D optional?

required to buy medicare drug plan
Required to Buy a Medicare Drug Plan?

Medicare Part D

I don’t take any prescription drugs. Why must I buy something I don’t need or want?

You are not REQUIRED to buy a prescription Medicare drug plan. But if you don’t enroll in a plan when first eligible you will pay a penalty.

And the penalty is payable for life. It also increases every year.

So . . .

Am I Required to Buy a Medicare Drug Plan?

Where Can I Find the BEST Plan?

Finding the best Medicare drug plan isn’t easy. Part D is the most confusing part of Medicare. How do I find the RIGHT plan for me?

You could get lucky this time, but what about next year?

Is there a GUIDE to Medicare Prescription Drug Coverage? Yes, and it is only 88 pages . . .

The best drug plan is the one that is right for you. Do the following before enrolling.

  • Use the Medicare Drug Plan Finder
  • Enter all your current medications
  • Choose a pharmacy. Look for the one with the lowest copay’s.
  • Make sure all your drugs are on the formulary
  • Consider buying generics with cash or a discount card
  • Look for plans with a deductible
  • Enroll in a plan with the lowest total out of pocket cost

You can do all this by yourself.

Or you can ask a Medicare expert to help. I am always willing to help my Medigap clients. If you are not a client, please don’t ask. It’s not personal, it’s just business.

Why is Medicare Confusing?

Seniors often buy the wrong drug plan and spend too much on their prescription plan. Seniors on Medicare spend an average of $263 per month on prescription medications.

Lower your medication bill by only using your drug card when necessary. The right drug plan will save a lot on brand names but you will almost always pay MORE for generics.

Consider paying cash or using GoodRx instead for maximum savings. Also look for a Medicare drug plan with a deductible. https://youtu.be/LaA9NnFeBXI

You have questions? I have answers. Call or email.

#MedicareDrugPlan #MedicarePartD #GAMedicareExpert

Don’t Buy a Medicare Drug Plan

shopCompareBig_new2

Don’t buy a Medicare drug plan. Don’t buy it from Blue Cross, AARP, Humana or any other carrier. Don’t buy a drug plan from a company website. Don’t buy Part D from an agent. Not any agent.

And that includes me.*

don't buy a medicare drug plan

don’t buy a medicare drug plan

But you should allow me to review available drug plans (there are currently more than 20 of them) and suggest the best drug plan / pharmacy combination that produces the lowest out of pocket cost to you.

We recently showed 2 different clients how to save over $4,000 per year

by switching plans AND pharmacy’s.

 

Don’t Buy a Medicare Drug Plan That Has a Deductible

Unless you understand how much money you could save.

Drug plan deductibles are confusing to consumers.

But many agents also don’t understand them.

So we made this video just for you.

 

We Shop – You Compare

How easy is that?

I will also shop the market for you and suggest the best GA Medigap plan. With more than 170 different Medicare supplement plans in Georgia, you will be overwhelmed and confused.

I can distill your options down to a handful of plans and carriers to consider in less than 10 minutes and show you why some plans deliver the best value while the rest really stink.

Click now to shop and compare GA Medigap quotes now.

Your information is never sold.

 

Don’t  buy a Medicare drug plan direct

Depending on where you live in Georgia, there could be as many as 30 different Medicare drug plans offered by over a dozen different carriers.

atlanta gaMonthly premiums start in the mid teen’s and your annual projected drug costs could be anywhere from a few hundred dollars to tens of thousands of dollars.

Don’t buy a drug plan direct from a carrier.

If you call Blue Cross, or Humana, or Aetna or any of the other carriers offering drug plans what will you get?

A sales pitch about their plans.

They won’t tell you about plans from other carriers that might be better. They may even forget to mention other ways to save money on your prescription drugs.

Of course you can always just shop online at the carrier sites.

Click to find the drug plans.

Click to enter your medications and dosage.

Click to pick a pharmacy from the preferred list.

Click to review plan options and drug costs.

Then when you are through go to another carrier site. Wash. Rinse. Repeat.

How much fun is that?

John C. of Atlanta saved over $500 per year by purchasing his Medigap plan through Georgia Medicare Plans

 

Don’t buy Medicare Part D from an agent.

Never buy your drug plan from an agent.

Not any agent.

bob on fbIncluding me.

Why?

Legally, an agent can only tell you about plans they are certified to present. Most agents are only approved to discuss a few plans from maybe 2 or 3 carriers.

Out of 20+ drug plans that may be in your area most agents can only legally discuss maybe 3 or 4.

What about the other plans?

Medicare does not allow them to tell you about better plans, only the few they are approved to offer.

The same rules apply to Medicare Advantage plans.

When an agent tries to sell you an Advantage plan they can only discuss the ones they are approved to offer. And they are not allowed to compare one plan against another.

Currently Marietta, Georgia has 11 different Advantage plans from 6 different carriers. It the agent that is hoping to sell you a plan is only appointed with two of the carriers, not only can they not compare the two plans for you but they can’t tell you about plans from the other 4 carriers.

There are over 240 different Medigap plans in Marietta and I am allowed to discuss any or all of them and give your rates on any of them by phone or email.

Doesn’t that make more sense?

shopCompareBig_new2

 

 

Where should you buy a Medicare drug plan?

Don’t buy it from a carrier.

Don’t buy it from an agent.

The only place you will get information on EVERY drug plan in your area is at 1-800-MEDICARE (1-800-633-4227)

The people that answer the phones can tell you about every plan available to you, even the ones that don’t pay a commission to an agent.

You can buy a drug plan at 3:00 AM or 3:00 PM.

Seven days a week.

24 hours a day.

Except on federal holidays

You can get informed and unbiased information on Medicare Part D prescription drug plans.

The best time to call is usually after 7:00 PM week nights.

Here is what you will need:

  • The exact name and dosage of each medication
  • How often refilled
  • Drug refill quantity
  • Retail or mail order
  • Preferred pharmacy

But let us help you with your Medicare supplement options AND show you how to save money on Medicare Part D year after year

Here’s why.

 

Do not buy a Medicare supplement plan from Medicare

You certainly can if you wish. But consider this.

  • Medicare.gov only gives you premium ranges, not exact rates
  • Medicare.gov only has a few carriers and most of the information is outdated
  • You won’t learn who is new to Georgia and who has been writing business for years
  • You won’t learn which carriers are pulling out of Georgia
  • You won’t know about past or future rate increases
  • You won’t learn which plans were dropped by carriers
  • You won’t learn which carriers stopped writing business under an old name and started with a new one
  • You won’t learn about average annual rate increases
  • But you can buy a plan 24/7 if you are in a hurry and don’t care about any of the above items

When you allow Bob Vineyard at Georgia Medicare plans to assist, you get the benefit of 40 years experience in the health insurance business.

Or you can buy from a carrier or Medicare.gov and hope the person answering the phone can really answer your questions.

We can discuss all of the 240 Medigap plans, tell you which ones are due for a rate increase, which have a history of huge rate increases and which carriers don’t yet have a track record. We will provide you with rates by phone and email.

Click to shop

 

#MedicareDrugPlans #MedicarePartD  #Don’tDoDrugs

Medicare Part D – What You Need to Know

Medicare Part D can be a snake pit if you don’t understand how it works. Medicare Part D can be a blessing for some but a nightmare for others. Seniors age 65 and older are not required to buy a Medicare Part D plan, but if you don’t and then later change your mind, you will be subject to a Late Enrollment Penalty (LEP) of 1% per month.  (Updated 6/6/2018)Medicare Part D - Drug Coverage - PDP

If you were eligible to buy a Medicare Part D plan when you turned 65 but waited 3 years to buy one, you would pay a LIFETIME PENALTY in 36% additional premiums.

Medicare Part D Traps and Penalties

In 2003, Congress enacted the Medicare Modernization Act that would forever change benefits, especially as it impacts the cost of prescription drugs. Did you know . . .

  • Outpatient prescription drugs are not part of original Medicare, but rather a private insurance product marketed and administered by  insurance carriers.
  • Pharmacy Benefit Managers (PBM) negotiate pricing tiers for prescription drugs but the insurance carriers decide which drugs to include in their plan
  • Insurance carriers also assign tiers and copays for the Prescription Drug Plan (PDP) as well as setting the premium you pay
  • Medicare Part D is a voluntary plan but you will pay a penalty if you fail to enroll on a timely basis
  • Once enrolled, you must remain in the plan until the next enrollment period BUT your plan can add or drop drugs during the year as they see fit
  • Non-formulary drugs do not count toward your deductible or Rx out of pocket maximum

How do you enroll in Medicare Part D?

You should start by making a list of all your current medications by name. Include the dosage and how often you fill your prescription.

Next, use the Medicare Prescription Drug Formulary Plan Finder to determine which plan is best for you.

You can also call 1-800-MEDICARE and ask for assistance.

If you have a regular pharmacy, such as CVS or Walgreens, you can take your list of prescription drugs to your pharmacy and ask them for assistance in selecting a Medicare Part D plan. Just understand they will show you plans where they are the PREFERRED vendor. There may be other plans with lower copay’s.

Georgia Medicare Plans offers affordable Medigap rates and information on how to find the best Medicare Part D plan to fit your needs and budget.

#MedicarePartD  #MedicarePrescriptionDrugPlan #PDP