Savvy Senior

Dear Savvy Senior

What can you tell me about the shingles vaccine? I just turned 65 and have been thinking about getting vaccinated, but would like to know how effective it is and how it’s covered by Medicare.

Afraid of Needles

Dear Afraid,

Older adults who get the shingles vaccine can actually cut their risk of getting the painful condition in half, and those that do happen to get it are likely to have a milder case if they’ve been inoculated. Here’s what else you should know about the shingles vaccine, along with how it’s covered by Medicare.

Shingles Overview

Shingles, also known as herpes zoster, is a burning, blistering, often excruciating skin rash that affects about 1 million Americans each year. The same virus that causes chickenpox causes it. What happens is the chickenpox virus that most people get as kids never leaves the body. It hides in the nerve cells near the spinal cord and, for some people, emerges later in the form of shingles.

In the U.S., one out of every three people will develop shingles during their lifetime. While anyone who’s had chickenpox can get shingles, it most commonly occurs in people over age 60, along with people who have weakened immune systems. But you can’t catch shingles from someone else.

Early signs of the disease include pain, itching or tingling before a blistering rash appears several days later, and can last up to four weeks. The rash typically occurs on one side of the body, often as a band of blisters that extends from the middle of your back around to the breastbone. It can also appear above an eye or on the side of the face or neck.

In addition to the rash, more than one-third who get shingles go on to develop severe nerve pain that can last for months or even years.

Vaccination Coverage

The Center for Disease Control and Prevention recommends that everyone age 60 and older should get a one-time shingles vaccination – called Zostavax. Even if you’ve already had shingles, you still need the vaccination because reoccurring cases are possible. See zostavax.com or call 877-974-4645 for more information or to locate a vaccine provider in your area.

The vaccine is also very safe. For most people the worst side effect is mild redness or arm soreness.

You also need to know that Medicare covers the shingles vaccine as one of its preventive benefits. But, unlike some other vaccines that are paid through Part B, the shingles vaccination is covered by Part D.

If you have a Part D prescription drug plan, it will pay for the vaccine itself and for your doctor or other health care provider to give you the shot. You are only responsible for paying the plan’s approved copay at the time you get vaccinated, which usually runs around $60 to $80.

But, you need to make sure you follow your plan’s rules in order to keep your out-of-pocket costs down.

If you’re vaccinated at a drugstore, check to make certain it’s in your Part D plan pharmacy network. Otherwise, the shot will cost you more than your usual copay.

If you’re inoculated in a doctor’s office, check to make sure the office can bill your plan or at least can work through a drugstore in your plan’s network. Otherwise, you’ll have to pay the entire bill upfront and then claim reimbursement from your plan.

Just to be safe, call your Part D drug plan ahead of time and ask which pharmacies and doctors in your area you can use to receive the shingles vaccine at the plan’s regular copay.