If you’re wondering “Does Aetna Medicare cover the shingles vaccine?” you’re not alone. Shingles can be a painful condition and getting the vaccine can help prevent this. But does your Aetna Medicare plan have your back when it comes to the shingles vaccine? Let’s dive into the details.
What is Shingles?
Before we get into coverage let’s first talk about what shingles actually is. Shingles is a viral infection caused by the varicella-zoster virus—the same one responsible for chickenpox. If you’ve had chickenpox in the past the virus may reactivate later in life causing shingles which can lead to painful rashes and long-term nerve pain. Not fun. So it’s no surprise that many people want to get vaccinated against it.
Does Aetna Medicare Cover the Shingles Vaccine?
Medicare Part B
Many assume Medicare Part B would cover the shingles vaccine like it does for flu shots or pneumonia vaccines. But nope. Medicare Part B does not cover the shingles vaccine. That’s right—you might get coverage for your annual flu shot but when it comes to shingles you’re left on your own.
Medicare Part D
The good news? Aetna Medicare Part D which is the prescription drug plan usually does cover the shingles vaccine. However coverage varies based on your specific plan so you may still have out-of-pocket costs.
What You’ll Likely Pay with Aetna Medicare Part D:
- Your deductible: If you haven’t met your annual deductible yet you might need to pay the full cost of the vaccine upfront.
- Copays/Coinsurance: Depending on your plan you might have a copay or coinsurance for the vaccine.
- Pharmacy network: Make sure the pharmacy where you get your shingles vaccine is part of Aetna’s network or you could be in for some surprises when you get the bill.
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Why Get the Shingles Vaccine?
“Shingles is like chickenpox’s revenge” says Henry Beltran the owner of Medicare Advisors Insurance Group LLC. “You’ve already suffered through the itchy mess of chickenpox then bam! Decades later it comes back angrier.”
Getting the shingles vaccine is a good idea for most people 50 and older even if you feel invincible. It’s especially important because shingles can cause long-term nerve pain—a condition called postherpetic neuralgia (PHN). So while it might feel like an unnecessary expense trust me it’s better than dealing with that kind of pain down the line.
How to Check Your Aetna Medicare Plan for Coverage
If you’re unsure whether your specific Aetna Medicare plan covers the shingles vaccine follow these steps:
- Log into your Aetna Medicare account or call customer service.
- Check your Part D drug formulary which should list the shingles vaccine under covered medications.
- Ask if your plan has any network requirements for where you can get the vaccine.
- Confirm any deductibles or out-of-pocket costs before heading to the pharmacy.
Potential Drawbacks of Getting the Shingles Vaccine with Aetna Medicare
Now let’s talk about the not-so-pleasant side of things. We always like to keep it real here!
The Cost Can Sneak Up On You
Even with Aetna Medicare Part D coverage some people may end up paying a lot more than expected if they haven’t met their deductible yet. You may go into the pharmacy thinking you’re paying for just a vaccine but leave feeling like you’ve also just funded part of the pharmacist’s vacation.
You Need to Find a Pharmacy in Network
Think your favorite pharmacy is always the best option? Think again! With Aetna’s Part D plan you’ll need to make sure the pharmacy you visit is in-network or your wallet might suffer. If your local pharmacy isn’t covered you’ll be paying more—and let’s face it who has time to research pharmacies when you’re already trying to dodge the shingles?
Timing is Everything
Got plans to get the vaccine at the end of the year? Be careful! If you haven’t met your deductible yet the timing of when you get vaccinated could make a big difference in how much you pay. Get it too early in the year and you might be stuck footing the bill before your deductible kicks in.
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Alternatives to Aetna Medicare Shingles Vaccine Coverage
If you’re finding Aetna’s coverage for the shingles vaccine to be a bit of a headache (pun intended) here are some alternatives:
- Shop Around: Some pharmacies offer discounts or promotions on vaccines for people without sufficient coverage. Check with local pharmacies like CVS or Walgreens.
- Community Health Clinics: Some clinics may offer vaccines at a lower cost especially for seniors. It’s worth calling around.
- Medicare Advantage Plans: Some Medicare Advantage plans (often called Medicare Part C) may offer better or more flexible coverage for the shingles vaccine.
The Bottom Line
“Nobody likes surprises especially when it comes to healthcare costs” says Henry Beltran. “With the right Medicare plan like Aetna you can reduce some of those surprises but it’s always good to be proactive and know exactly what your plan covers.”
If you’re looking for coverage on the shingles vaccine Aetna Medicare Part D is likely to have you covered—but it’s important to check your plan understand the costs and make sure you’re going to an in-network pharmacy. The cost of the shingles vaccine is well worth it when compared to the misery of shingles but always check with your plan before heading to the pharmacy.
- Don’t forget: Check your Part D deductible
- Make sure you use in-network pharmacies
- Ask questions to your provider if you’re unsure about coverage
Staying informed can help keep shingles at bay and your wallet happy.
