People With Medicare

Medicare Question of the Month

Each month, our expert showcases a Medicare question submitted by one of our readers. You may submit a question at any time and get a personal response.

This Month's Question:

• I need the shingles shot. Does Medicare pay for all or part of this cost?

Answer

Shingles is a painful skin rash caused by the same virus that causes chickenpox. And people age 50 and over are most at risk. It can cause lifelong pain even after the rash is gone. But you can prevent shingles by getting the shingles vaccination.

All Medicare Part D drug plans are required to cover the shingles vaccine. Part D plans have very specific rules about where you need to get the shot in order for the plan to cover both the injection (the vaccine itself) and the administration of it, that is to say, giving you the shot. You should call your Part D plan, and find out their specific coverage rules.
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Also, the amount you have to pay for the vaccine varies from plan to plan. You should contact your current plan to find out the costs specific to you. Your plan should be able to tell you what your cost-sharing amount for the vaccine is. The cost-sharing amount, or the amount you have to pay, can be either:

• A copayment (fixed amount such as $15), or
  
• A coinsurance (a percent of the drug cost such as 25%).

Ask your plan:

• How much do they charge you (your copayment or coinsurance) for the vaccine?
• Do you need to get the shot at your doctor's office in order to get coverage?
• Can you get the shot at a pharmacy or drugstore and get reimbursed by your plan?

The shingles vaccine can help you avoid a very painful and often lifelong condition that could limit your activities. Let Medicare help you stay healthy by getting the vaccine if you have not had it yet.

And if you have limited income and resources, you may be eligible for Part D Extra Help. This program helps you pay for certain Part D costs, such as the coinsurance and copayments, making the cost of your vaccine much more affordable. Learn more about Extra Help.

If you need help contacting your plan or applying for Extra Help, get personal help. You can also learn more about other preventive benefits covered under Medicare Part B.

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