Toni,
I was recently told if I was to receive a shingles vaccination, I need to have a Medicare Part D prescription drug plan 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, Arkansas
Sam,
I have fantastic news with some Medicare changes that you have been waiting for. Beginning Jan. 1, 2023, the Inflation Reduction Act eliminated all out-of-pocket costs for vaccines that the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommends for adults. This change is effective if you have drug coverage from a standalone Medicare Part D prescription drug plan or from a Medicare Advantage plan with Part D coverage.
Shingrix, which the Food and Drug Administration approved in 2017, is the only approved vaccine for shingles. The CDC recommends adults age 50 and over get two doses.
Without being enrolled in a Medicare Part D plan, you may have to pay more than $180 per dose of Shingrix. Sam, this is why you were told that you might have to pay $200 per dose for the vaccine.
Americans who are leaving employer group health insurance after age 65 or enrolling in Medicare for the first time (when turning 65 or before 65 if eligible) should enroll in a Medicare Part D plan with a standalone 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 to you.
If you have trouble affording the Medicare Part D prescription drug premium, you may qualify for Medicare's extra help program, which helps people with limited income and assets pay premiums and out-of-pocket costs for Part D drug coverage.
Those with a Medicare Part D plan can receive their Shingrix shots at their pharmacy or their doctor's office.
As for coverage under Medicare Part B, page 50 of the 2023 Medicare & You handbook states that some vaccines are covered under Part B, and that you may pay nothing for them as long as your health care provider accepts Medicare assignment. Part B will cover:
-- Flu shots.
-- Hepatitis B shots.
-- Pneumococcal shots.
-- COVID-19 vaccine.
Part B will cover other immunizations only if you have been exposed to a disease or condition, such as rabies shots for an animal bite or a tetanus shot for an injury/wound.
The handbook states that Medicare Part D covers other immunizations that Medicare Part B does not cover, such as tetanus, diphtheria and pertussis vaccines, to prevent illness. (The handbook advises you to talk with your doctor about which immunizations are right for you.)
It amazes me how Medicare makes a simple medical issue such as getting a vaccine so complicated. Remember, with Medicare, what you don't know will hurt you!
Toni King is an author and columnist on Medicare and health insurance issues. She spent more than 27 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. You can visit seniorresource.com/medicare-moments to listen to her Medicare Moments podcasts and get other information for seniors.