Community Chat

[SilleeMee]

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@Charlie Bear wrote:

I was told that the vaccine is paid for through your Part D if on Medicare. She said the previous vaccine was only 30% effective. Asked why the shortage and was told only one pharmaceutical company produces it. My physician strongly recommended that I get one. 

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Seems to be conflicting reports about Medicare coverage for this vaccine. I'm not on Medicare but I asked my pharmacist if Medicare paid for it and he said not entirely and that would depend on your plan.  I believe at one time Part D covered the old vaccine, Zostavax, but not 100% of the new Shingrix. There is some confusion about doctor-ordered vaccines and the billing process that goes through Part D. I am not familiar about that at all. What is important is to make sure you have an insurance plan that covers the vaccine and that the pharmacy who gives the shot falls under that plan.

[151949]

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@Charlie Bear wrote:

I was told that the vaccine is paid for through your Part D if on Medicare. She said the previous vaccine was only 30% effective. Asked why the shortage and was told only one pharmaceutical company produces it. My physician strongly recommended that I get one. 

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My part D it is considered a tier 4 drug and I have a  deductible to meet at that level before they pay anything, so mine was all out of pocket. You have to check with your part D provider.

[SilleeMee]

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@151949 wrote:

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@SilleeMee wrote:

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@151949 wrote:

When I got my first shot at Publix I paid for both, so when it's time for me to get the second shot in Oct. they darn well better have one for me since I already paid $160 for it.

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I believe they charged you for the first one only. The Shingrix vaccine is expensive and the average cost for both is about $280 (w/o ins). Payment in advance for the second one is not taken. Pay as you go...as they say. @151949

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Depends on the pharmacy. Mine won't take payments in advance for shots I haven't gotten yet. 

[151949]

@SilleeMee It depends on what tier your ins co puts it at and what your part D plan covers at that tier.

[SilleeMee]

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@151949 wrote:

@SilleeMee It depends on what tier your ins co puts it at and what your part D plan covers at that tier.

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I am not on Medicare. I'm 63 and have private insurance. My insurance company gets billed each time the vaccination is given to me. @151949

[DiAnne]

I got mine at Costco.  My insurance paid so no charge.  They saved a second dose for people so the shortage was no problem.  

[lulu1]

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@FrostyBabe1 wrote:

My insurance doesn't cover either of the shingles vaccines. When I contacted the insurance company, they said it's only covered once one reaches Medicare age, and then only under some of their Medicare plans. I have several years before I'll be eligible for Medicare and I'm really not feeling paying for it out of pocket, but we'll see. 

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There was a time insurance began paying once the patient reached 60 not Medicare. Prior to 65, private insurance companies can do pretty much what they want.

My feeling was, despite the fact it was an expensive shot, it was worth every penny.  I've had shingles and the pain was EXCRUCIATING.  Six months later I still had nerve pain.