Shingle is a viral infection caused by the varicella-zoster virus, the same virus that can cause chickenpox. It affects the skin surface, sensory ganglion, and nerve supplies. A person can get shingles only if they have had chickenpox or were exposed to the varicella-zoster virus. A person can catch shingles from another by contact because the virus is present in the blisters. The virus can lie dormant for a long time. Its symptoms include rashes accompanied by fever, headache, or chills. It also makes patients sensitive to touch.
Who can develop shingles?
Many people over the age of 50 are commonly affected by Shingles, but it can appear at any stage if a person has had chickenpox previously. According to the Centres for Disease Control and Prevention (CDC), almost 1 in 3 people in the United States of America develop shingles during their lifetime.
Does Medicare cover the shingles vaccine?
Medicare part A and Part B do not cover the vaccine, but it is possible to get coverage through a Medicare Advantage or Medicare Part D plan. Medicare part D covers prescription drugs and "commercially available vaccines." Medicare mandates that shingles vaccine be covered by part D, but the amount it covers may vary according to the plans.
How to make sure that you are covered?
- Call your doctor to make sure if it's possible to bill your part D plan directly.
- If your doctor cannot bill your plan directly, you can ask them to coordinate with a pharmacy within the network.
- You can file your vaccine bill for reimbursement with your plan if either option mentioned above is not possible for you.
How much does a shingles vaccine cost?
Usually, the price of the vaccine depends on your Medicare coverage. If you only have the original Medicare plan but no prescription drug coverage, you might need to pay the total price. Medications are grouped in tiers, and the cost of a drug depends on what tier the drug falls in. At least 50 percent of the retail value of a drug is covered by Medicare plans.
The shingles vaccine Shingrix, a two-shot series, costs about 50 dollars per shot for people with Medicare part D and has a retail price of about 192 dollars.
How does Shingrix work?
Shingrix contains no live virus and is given intramuscularly. The second shot is given after two to six months of the first shot. Its efficacy rate is about 97 percent in adults in their 50s, over 97 percent in people above 60, and 91 percent for 70 and above. It uses a non-live antigen with a specifically designed adjuvant. It has a single protein found in the outer shell of the herpes zoster virus and has an adjuvant to increase the body's immune response. Because it does not contain a live virus, it is recommended for people who are immunocompromised. The immune response usually begins four weeks after the second dose, and the series does not need to be restarted if more than six months have passed since the first dose.
Shingrix vs. Zostavax:
Another vaccine called Zostavax contained a live, weakened form of the zoster virus and was injected subcutaneously. However, Zostavax had an efficacy of 50-60 percent in preventing shingles in people aged 50 to 70 and lower in people over 70. A Research found out that Shingrix stimulates the immune system to produce more antibodies and generates a 24-fold increase in T cells over Zostavax. While Shingrix offers protection for up to four years, in reality, its effects last much longer. The second dose is essential to ensure long-term protection. It also increased the risk of strokes and heart attacks and was finally taken off the market after several lawsuits. Also, The CDC's Advisory Committee on Immunization Practices (ACIP) recommends that healthy adults who previously received Zostavax can be revaccinated with Shingrix to prevent shingles and related complications.
Which vaccines are covered by original Medicare?
Part A covers inpatient hospital stays, and Part B covers doctor's services, outpatient care, medical supplies, and preventive services. Here are some of the vaccinations covered by plan B:
- Influenza shots, including both the swine flu vaccine and the seasonal flu vaccine.
- Pneumococcal shots for pneumonia
- Hepatitis B shots
- COVID-19 vaccines, although it has not been approved or readily available to everyone yet.
- Tetanus shot for wound management
- Rabies vaccine
What immunizations are covered by Medicare Part D?
Medicare part D covers all immunizations that are not covered by part, that includes:
- Tdap (tetanus, diphtheria, and pertussis)
- Shingles shot
- Varicella (chickenpox)
How much do these vaccines cost?
The cost for these vaccines is determined by the portion of Medicare paying for them and their type. You don't have to pay for vaccines covered by Medicare part B, but you need to check with your insurance plan if you have Medicare part B. if you are getting a shot covered by Part D, your insurance company will negotiate a price that includes the vaccine expenses and its administration. The costs include:
- Dispensing fee
- Vaccine administration fee
- Vaccine ingredient cost
- Sales tax
