Understanding Shingles and Shingrix Vaccine Coverage
The Centers for Disease Control and Prevention (CDC) estimates that 1 million Americans get shingles every year. The National Institute on Aging states that about half of those cases are in adults ages 60 or older. Shingles, or herpes zoster, is caused by the varicella-zoster virus, which also causes chickenpox. It can lead to a painful rash, blisters, and post-herpetic neuralgia (PHN).
Prevention with the Shingrix Vaccine
For older adults, especially those with weakened immune systems, Shingrix offers a highly effective way to prevent shingles. The Shingrix vaccine is over 90% effective in preventing shingles in adults over 50 years old, according to its manufacturer, GSK.
Are Shingles Vaccines Free?
Yes, for most people, the shingles vaccine is free. Most Medicare Part D plans cover it because they are legally required to cover all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), which includes Shingrix. However, some plans may require you to pay upfront and then submit a request for reimbursement. Regardless, Medicare Part D beneficiaries typically do not pay out of pocket, including copays.
If you only have Medicare Part A or Part B without an add-on Part D plan, you might not receive coverage. Medicare Advantage plans (Part C), which often include Part D, usually cover it. Additionally, Medicaid usually covers Shingrix, but coverage can vary by state.
Coverage Under Private Insurance
Even without Medicare Part D or Medicaid, you might still get Shingrix for free through private insurance plans. Private insurance plans typically cover ACIP-recommended vaccines like Shingrix. According to the Shingrix website, 96% of people with private health insurance plans won’t pay anything out of pocket, though some plans may still have copays, coinsurance, or other cost-sharing expenses.
Eligibility for the Shingles Vaccine
To be eligible for Medicare coverage and receive the shingles vaccine for free, you must be 65 years old. However, individuals younger than 65 with private healthcare plans can potentially have it paid for, depending on their insurance plan’s formulary.
Cost of Shingrix Without Insurance
For those without Medicare or private insurance, the out-of-pocket cost for each dose of Shingrix is approximately $275.88, totaling $551.76 for the two-dose series. However, Shingrix’s manufacturer offers a patient assistance program called GSKForYou to help eligible individuals.
Where to Get the Shingles Vaccine
You can get the Shingrix vaccine at most commercial pharmacies, doctors’ offices, community health clinics, local health departments, and workplace health clinics. The vaccine’s website has a shingles vaccine locator tool, and pharmacy chains also provide information on how to get it.
Conclusion
Understanding the coverage and costs associated with the Shingrix vaccine helps you take proactive steps in preventing shingles. For personalized assistance with Medicare Part D or other health insurance plans, contact us at 833-739-1122. We simplify your health insurance search by comparing top plans to find the best, affordable coverage suited just for you. Picking the wrong health insurance policy can cost you, and the best options are usually not advertised. With millions enrolled in Medicare and ACA, personalized coverage is crucial not just to your wallet but to your health. Let us navigate the complex options to find the best plan for you.
