UNITED STATES—Toni: I was recently told if I was to receive a shingles vaccination, I need to have a Medicare Part D prescription drug plan to get the vaccination or pay $200. I thought all vaccinations and immunizations were covered at no cost.
Can you please explain how I can receive this benefit? Thank you, Sam, Little Rock.
Sam: I have fantastic news for America with some Medicare changes that you have been waiting for! Beginning January 1, 2023, the Inflation Reduction Act eliminated all out-of- pocket costs for vaccines which the CDC’s Advisory Committee on Immunization Practices recommends for adults. This change is effective whether you have drug coverage from a standalone Medicare Part D Prescription Drug plan or from a Medicare Advantage plan with Part D coverage. Now the shingles vaccine is included at no cost with the Shingrix vaccine.
If you have trouble affording Medicare Part D prescription drug premium, you may qualify for the Medicare’s Extra Help program, a government program that helps people with limited income and assets pay premiums and out-of-pocket costs for Part D drug coverage.
Without being enrolled in a Medicare Part D plan, then you may have to pay more than $180 per dose for Shingrix, a vaccine that the Food and Drug Administration approved in 2017. Shingrix is the only approved vaccine for shingles at this time.
Sam, this is why you were told that you might have to pay over $180 per dose for the vaccine. It is very important for those leaving employer group health insurance after 65 or enrolling in Medicare for the first time (when turning 65 or before 65 if eligible) to be sure to enroll in a Medicare Part D standalone prescription drug plan, with or without a Medicare Supplement, or a Medicare Advantage plan with Part D. You will want your shingles vaccine to be covered at no cost.
Those with a Medicare Part D plan can receive their Shingrix shingles vaccine at the pharmacy or at your doctor’s office.
On page 50 of the 2023 Medicare & You handbook, it explains how shots (or vaccines) flu, hepatitis, pneumonia shots and COVID-19 vaccines are covered under Medicare Part B. The handbook states that shots (vaccines) are covered under Medicare and that you may pay nothing for the shot as long as your doctor or other health care provider accepts Medicare assignment. It is important to make sure your doctor is accepting Medicare assignment.
Also page 50 discusses that Medicare Part “D” covers other adult immunizations that Medicare Part “B” does not cover such as tetanus, diphtheria, and pertussis vaccines to prevent illness. The Medicare & You handbook advises you to talk with your doctor about which immunizations are right for you.
Medicare covers some vaccines and immunizations. The way Medicare covers them, depends on which vaccine you need. Below is what page in the Medicare and You handbook that Medicare Part B will cover vaccines to prevent:
a) Influenza (the flu) currently the seasonal flu shot See pg. 41.
b) Hepatitis B (if you are at medium or high risk) See pg. 42.
c) Pneumococcal Shots (Pneumonia) See pg. 48.
d) COVID-19 vaccines and testing See pg. 37.
Part B will cover other immunizations only, if you have been exposed to a disease or condition such as rusty nail for Tetanus or if you are bitten by a dog or strange animal, then Medicare will cover rabies.
It amazes me how Medicare can make a simple medical issue such as getting a vaccine so complicated. Remember, with Medicare it’s what you don’t know WILL hurt you! If you have a Medicare question, email email@example.com or call 832-519-8664.
Visit www.seniorresource.com/medicare-moments to listen to Toni’s Medicare Moments podcasts. Toni’s “Medicare Survival Guide Advanced” edition available at www.tonisays.com.