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Coverage for the Shingles Vaccine

Q. Does Medicare cover the shingles vaccine?

A. Yes, but not in the way you might expect.

Other common vaccines are covered under Medicare Part B. In other words, you get them in a doctor’s office, then the doctor bills Medicare and—in the case of flu and pneumonia shots—Medicare picks up the full tab.

But the shingles vaccine is covered under the Part D prescription drug program. That means you must be enrolled in a private Part D plan (a stand-alone drug plan or a Medicare health plan that covers drugs), get the vaccine through your plan and pay whatever share of the cost that your plan requires.

You shouldn’t have any problem obtaining the shingles vaccine through your drug plan. Under Medicare regulations, all Part D plans must cover it.

But there are some pitfalls to watch out for in terms of paying for the shingles shot, depending on where you receive it:

* If you’re vaccinated at a pharmacy, make sure it’s one that is in your Part D plan’s pharmacy network. Otherwise, the shot will cost you more than the plan’s normal copayment, perhaps even full price. (Every state except Maine allows pharmacists to give vaccinations.)

* If you’re vaccinated in a doctor’s office, make sure the doctor can bill your plan directly through its computer billing process, or can work through a pharmacy in your plan’s network that can also bill the plan directly. Otherwise, you’ll have to pay the entire bill upfront and then claim reimbursement from your plan.

The bottom line: Call your plan in advance and ask which pharmacies and doctors in your area you should use to receive the shingles vaccine at the plan’s regular copay.

Patricia Barry is a senior editor at the AARP Bulletin.

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