Good Morning Toni:
I was recently told that to receive a shingles vaccination I needed to have a Part D (Medicare 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? Thank you, Sam from Cypress, TX
Hello Sam:
This is such a great question because during the fall, there are so many ads on flu shots at no cost!
Shingles vaccine is covered under Medicare Part D, your company group retirement or health insurance or the VA for Vets. Don’t have one of these options, you will have to pay the whole cost of the vaccine. Today the cost of a shingles vaccination is $150 to $300.
On pages 43, 44 & 48 of the 2014 Medicare & You handbook, it explains how flu, hepatitis, and pneumonia shots are covered. The handbook uses the word “generally” covered and that you may pay nothing for the shot as long as your doctor or other health care provider accepts Medicare assignment for giving the shot. Make sure your doctor is still accepting Medicare assignment.
Other vaccinations such as shingles are covered differently and I would talk with my doctor’s office before I receive the vaccine because the cost may be different.
Let’s examine how to file a claim for this service. There are 2 different ways to receive a flu shot or vaccination either through “Original Medicare” (the Red, White & Blue card) with a standalone Medicare Part D prescription drug plan or from a Medicare Advantage Plan with Prescription Drug plan. Filing a claim is different if you have “Original Medicare” or have a Medicare Advantage plan.
Medicare covers some vaccines and immunizations. The way Medicare covers them, depends on which vaccine you need. Part B of Medicare will cover vaccines to prevent:
a) Influenza (the flu) currently the seasonal flu shot which includes both a seasonal flu shot and an H1N1(swine flu) vaccination
b) Pneumonia; and
c) Hepatitis B (if you are at medium or high risk)
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.
Since January 2011, all Part D (Medicare Prescription Drug) plans must include all commercially available vaccines on their formularies, including vaccines for shingles (herpes zoster). The Part D (Medicare Prescription Drug) plan will pay for the vaccine and for the doctor to administer it, but you will need to make sure you follow your particular plan’s rules for the vaccine to be covered.
Always, check with your Medicare Part D (Medicare Prescription Drug) plan before you get your vaccine; see where and how you should get your shot. If you do not have a Part D plan then you will have to pay the cost of the vaccine.
Here are a few tips to help control the cost:
a) Choose a pharmacy that is in your Medicare drug plan’s network or
b) A doctor’s office that…
- Can work with a pharmacy that will bill your Part D plan for the entire cost of the vaccination process, or
- Can bill your plan for the vaccine directly using a special computer billing system.
For those that have a Medicare Part D Standalone prescription drug plan, the pharmacy/provider that you pick, should file directly with Medicare. Make sure that the pharmacy/provider accepts your plan. If you have a Medicare Advantage plan, please check with the primary care physician or pharmacy/provider who you want to file the claim. If they do not accept your plan, then you may pay 100% out of your pocket.
Toni King is the author of Medicare Survival Guide is available only at www.tonisays.com and not sold in bookstores. Toni is an advocate/consultant for those “Confused about Medicare”. Contact Toni if you would like a workshop for your church, organization or a company lunch and learn at www.tonisays.com/ask-toni or call 832/519-TONI (8664).
