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?
Sam, Little Rock
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 that 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 Shingrix is available at no cost.
If you have trouble affording a Medicare Part D prescription drug premium, you may qualify for 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.
If you are not enrolled in a Medicare Part D plan, then you may have to pay more than $180 per dose for Shingrix.
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 the age of 65, or when enrolling in Medicare for the first time 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 a pharmacy or at their 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 the Medicare assignment. It is important to make sure your doctor is accepting Medicare assignments.
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.
The way Medicare covers vaccines depends on which one you need. Below is what page in the Medicare and You handbook that Medicare Part B will cover vaccines to prevent:
- Influenza (the flu) currently the seasonal flu shot See pg. 41.
- Hepatitis B (if you are at medium or high risk) See pg. 42.
- Pneumococcal Shots (Pneumonia) See pg. 48.
- 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 protected] or call 832-519-8664.
Toni King is an author, columnist, and radio and TV personality who specializes in Medicare, Social Security, and long-term care planning. While conducting a Medicare workshop in 2009, Toni was approached by a member of the audience who had received incorrect information about his Medicare Part B enrollment from Social Security. After taking a couple of days to help the gentleman straighten out his overwhelming problem, Toni’s new mission had become clear. Following more than 27 years as a top sales leader in the Medicare insurance industry, Toni would become an advocate for Americans receiving Medicare. Since then, Toni has devoted her life and career to putting Medicare into “people terms” with the help of her books, consultations, workshops, and website, ToniSays.com. Read more from Toni King here!
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