Q: I’m helping my mother who is 70 with her doctor’s appointments. The doctor recommended a shingles, and a pneumonia vaccine. I know Medicare covers flu shots, but what about these?
A: Medicare covers both, but like all things Medicare, vaccine coverage isn’t always simple. Pneumonia vaccines are covered under Part B, and shingles vaccines should be paid for by your mother’s Part D plan.
Pneumonia is a very serious infection that in its worst forms kills one in every four to five people over the age of 65. The Medicare website states that Medicare Part B covers “one pneumococcal shot and a different second shot 11 months after the exam where you got the first shot.”
It’s important for you and your mom to know, however, that health officials updated pneumococcal vaccine recommendations in 2013 and 2014, so even if your mom has been vaccinated before, your mother’s doctor may recommend an additional vaccine to stay protected. There are two types of pneumonia vaccines (PCV13 and PPSV23) and the Centers For Disease Control recommends both for all adults age 65 years and older. In addition, doctors recommend getting a booster of each, especially if the patient has asthma, diabetes, lung, heart, liver disease or alcoholism, is a cigarette smoker, or is a resident of a nursing home. While Medicare may only pay for two shots, your mom’s Medigap or Medicare Advantage plan may cover the rest, so call and check with her health plan.
Shingles, which is also called zoster, is a painful, blistery skin rash that can occur in people who have had chicken pox. The vaccine should be covered by your mom’s Part D plan. However, the amount you pay could vary based on where she gets vaccinated. Since the one - time vaccine can cost $200 - $300, you should check the rules of your mother’s Part D plan ahead of time to see where she should get the shot for the lowest cost. She will pay the least if she is vaccinated at a pharmacy that is in her drug plan’s network or, a doctor’s office that can either work with a pharmacy that will bill your Part D plan for the entire cost of the drug and administering the injection, or will bill your plan directly.
Talk to your mom’s doctor to learn more about the shingles vaccine, which prevents the disease only 50 percent of the time. In patients who do get shingles anyway, the vaccination can prevent post-herpetic neuralgia, the sometimes debilitating pain that can persist after the shingles rash clears.
To learn more, visit www.Medicare.gov or call 1-800-Medicare 1-800-633-4227.
