How much will a shingles shot cost on Medicare and does Medicare actually cover the shingles shot?

A client asked today, How much will a shingles shot cost on Medicare and does Medicare actually cover the shingles shot (Zostavax) (Thanks to Nancy Kachinski for the question)

To answer the question we need to dig a little further.

1. What type of Medicare Coverage do you currently have:

a. There are several answers to that question that come to mind.

b. Select one and scroll down.

     i. Original Medicare (which includes part A and Part B)

     ii. Original Medicare with are Part D Prescription Drug Plan

     iii. Original Medicare and a Medicare Supplement (Medigap) with are Part D Prescription Drug Plan

     iv. Original Medicare with Group Insurance v. Original Medicare with Medicaid

     vi. Original Medicare with Medicaid replaced by an Medicare Advantage Plan (with part D)

     vii. Original Medicare, replaced by an Medicare Advantage Plan (with part D)

     viii. Original Medicare, replaced by an Medicare Advantage Plan (without part D)

     ix. Original Medicare with V.A Benefits

     x. Original Medicare with Tricare for Life

 

So…

The Shingles (Herpes Zoster) shot (http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-shingles.pdf) is a drug (Zoztavax) produced by MERCK. ZOSTAVAX works best against Shingles if you get vaccinated while you are in your sixties. In fact, once you reach 60 years of age, the sooner you get vaccinated, the better your chances of protecting yourself from Shingles. ZOSTAVAX is given as a single shot. ZOSTAVAX cannot be used to treat Shingles, or the nerve pain that may follow Shingles, once you have it.

As for cost, find your answer are below.

i. Original Medicare (which includes part A and Part B)

Full Price (no coverage offered by Medicare parts A and B), Walgreens says on Medicare the price is $179 administered at the Pharmacy (Sun City Arizona 7/12/2011)

ii. Original Medicare with are Part D Prescription Drug Plan

ZOSTAVAX is Medicare Part D covered drug so the cost will vary from a low of around $43 (MedicareRx Rewards Plus (PDP) 2011 Maricopa County) to a high of $162 Community CCRx Basic (PDP) which is negotiated cost of the drug prior to satisfying the annual deductable ($108.81 if the annual deductable is already satisfied)

iii. Original Medicare and a Medicare Supplement (Medigap) with are Part D Prescription Drug Plan

Same answer as ii.

iv. Original Medicare with Group Insurance

This varies greatly from $400 to the $160. Your negotiating skills will afford the best price.

v. Original Medicare with Medicaid

This varies from $90 to the $0, Depending on the level of assistance you receive.

vi. Original Medicare with Medicaid replaced by an Medicare Advantage Plan (with part D)

This varies from $6.30 to the $0, Depending on the level of assistance you receive.

vii. Original Medicare, replaced by an Medicare Advantage Plan (with part D)

This varies from $45 to 88 in Maricopa County Arizona (i.e. Scan Health Plan 2011 Maricopa County formulary $65, Cigna Medicare Select Plus RX (HMO) 2011 Maricopa County formulary $45, Secure Horizons Medicare Complete 2011 Maricopa County formulary $ 88)

viii. Original Medicare, replaced by an Medicare Advantage Plan (without part D)

This varies greatly from $400 to the $160. Your negotiating skills will afford the best price.

ix. Original Medicare with V.A Benefits

The V.A. does offer ZOSTAVAX to patients over age 65. Supplies are limited but available. The cost varies by Priority Group from $0 to $15 for a visit and as much as $9 for the shot. According the VA 2011 Copay Rates Fact Sheet 16-1 published January 2011

x. Original Medicare with Tricare for Life

If you have Part D and Tricare, see answer ii

If you do not have Part D then Tricare will pay a portion of the cost.

Hint, if you have Tricare, you most likely have access to V.A. Benefits. See answer ix.

From 12/3/2010 http://www.tricare.mil/faqs/question.aspx?ID=1741 “TRICARE For Life Beneficiary: Medicare only covers the shingles vaccine under Medicare Part D (Prescription Drug Plan). If you don’t have Medicare Part D, TRICARE will be the primary payer for the vaccine. You may get the shingles vaccine from any TRICARE-authorized provider (network or non-network). Standard/Extra deductibles and cost shares apply. The cost sharing waiver doesn't apply to TRICARE beneficiaries who are Medicare-eligible.”

I hope this answers the question for many folks. It took about 30 minutes on the phone with Medicare to discover what is and is not covered. After that we spent about 4 hours researching the internet and calling pharmacies to verify our information.

 

Please consult your plan directly for your plan benefits. Medicare is happy to answer questions at 1-800-Medicare, if you have Medicare and a Medicare Supplement. If you have replaced your Medicare with a Medicare Advantage Plan (Medicare Part C als know as a Medicare HMO, PPO, or PFFS) call your plan directly. Call the V.A. or Tricare or your Group plan if that allpies to your situation.

 

For more questions regarding any subject surrounding Medicare and your retirement plans , call, click or email anytime.

 

I am David P. Schaeffer, The American Retirement Advisor 877-220-1089  david@ara123.com

 

 

_______________________________________________________________________

 

David P. Schaeffer, CLTC, CSA

Practicing Retirement Planner

Publisher of "The American Retirement Advisor"

Best Selling Author of "Medicare Made 123 Easy"

602-281-3898           david@AmericanRetire.com
8355 E. Hartford Drive Suite 207 Scottsdale, AZ 85255

 

0 commentsDavid P. Schaeffer • July 12 2011 11:25PM

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