Shingles Vaccine

[GreenSky]

This is going to sound like "it's software"; no "it's hardware", but....

My understanding is all vaccines covered by Medicare should be covered by an MA plan, not under the Part D.

Yes?

Rick

 

[midwestbroker]

That sounds correct. I had a client that had the shingles vaccine and had to pay for it out of pocket and get reimbursed for it.

Unless the client got the vaccine as a prescription from the drug store and administered it themselves.

 

[MedSuppPro]

Just learned today from a client that Walmart is not going to be a provider for FirstHealth PDP's. Can anybody this?

 

[Guest]

As an adjunct to the topic, many IFP plans will cover the shingles shot. However, some carriers employ a "Catch 22" by requiring the shot to be given in a doctor's office, not a pharmacy.

The problem is that a lot of docs don't stock the vaccine because it has to be kept at a certain temp. Pharmacies are well-equipped for this.

Blue Shield of CA required me to have the shot at a doctor's office and my doctor would not buy the vaccine until he had proof in writing that Shield would pay for it (which Shield was happy to provide.)

A lot of people say "The hell with it" and just get it done at the pharmacy and pay out of pocket. The insurance carriers love that!

I know there are some folks who have to buy the vaccine at the pharmacy and rush to the doc to get the shot because the stuff has to be used within a certain time limit of being thawed.

The cost is about $200 where I live. Well worth the hassle of getting the shot... if you've ever known anyone who had shingles.

 

[bluediamond]

This is going to sound like "it's software"; no "it's hardware", but....

My understanding is all vaccines covered by Medicare should be covered by an MA plan, not under the Part D.

Yes?

Rick

That was also my understanding but BCBSFL recently told one of my MAPD clients it was covered under the drug benefit and would have to pay as a non preferred brand. I told many last AEP it was covered 100%. I guess if the doc won't do it then the pharmacy has every right to charge. I wish they would all get their together on this.

 

[Midlevel]

Mine have all gotten them at the pharmacy and run it through the PDP. Humana used to be $75.00 on the Enhanced Plan I believe.

 

[DS4]

Shingles vacc is covered under Part D

Covered under Part B,
Shots (vaccinations):

• Flu shots
• Pneumococcal shots
• Hepatitis B shots
• Other shots: Medicare helps pay for some other vaccines when they're directly related to the treatment of an injury or illness (like a tetanus shot after stepping on a nail).

 

[bluediamond]

Shingles vacc is covered under Part D

Covered under Part B,
Shots (vaccinations):

• Flu shots
• Pneumococcal shots
• Hepatitis B shots
• Other shots: Medicare helps pay for some other vaccines when they're directly related to the treatment of an injury or illness (like a tetanus shot after stepping on a nail).

Yep, found that out today at our annual meeting. It's still cheaper under Part D than paying full price.

 

[BeeSelective]

Obamacare will cover Shingles shot in 2014?, not sure how that will play into medicare.

Currently the Vaccine is covered by Part D. Dr may charge a fee for giving shot.

 

[retread]

Obamacare will cover Shingles shot in 2014?, not sure how that will play into medicare.

Currently the Vaccine is covered by Part D. Dr may charge a fee for giving shot.

Get your Zostavax at the pharmacy. Walgreens, Sam's, Kmart etc all offer it. CK your pharmacy benefits... I have PDP and it is Tier3 ($65) in network. Full price=$174.18

This vaccine requires special handling, and I would suggest you ask if the place you are getting your shot does a lot of them. If so, get the shot there. Doctor's offices may not be the best place, since they probably don't do as many. Use somebody that does it on a daily basis.

And as to the old post: It is not covered under Part B, but under Part D.