Does ObamaCare Cover Shingles?
Is a shingles vaccine free of cost?
Answer
The vaccine for Shingles (herpes zoster) is covered under the ACA. It's free on all ACA plans if you get it during your preventive care visit.
Learn more about free preventive care.
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It is my understanding that physicians do not carry the injection because it goes bad too quickly and you have to purchase it in quantity. Therefore, you have to get the prescription from the doctor and then go to the pharmacy to get it. Is it covered it you get it at the pharmacy? On all ACA plans? Even if you are under 50 years old?
Where you can get certain treatments depends on your health plan. Unless it’s an emergency, should always check with your health plan first to see how each item is covered.
I went to a Pharmacy. Explain a weakened immune system. Explained desire for Shingles protection. Cost $164.00. Was pharmacist obligated to inform of cost reduction through care Physician.
I am not sure what the rules for pharmacists are under the ACA. They typically will make you aware of such things, but I don’t know that it is a rule. I’ll try to find out.
I am age 60 and my physician gave me a prescription for the shingles vaccine because she does not keep it stocked in her office. My insurance (BC/BS) refused payment to the pharmacy for the vaccine, so I have not gotten it . I understand the vaccine is not covered unless given in the doctor’s office. Is this true that insurance does not have to pay if not given in the provider’s office? If so, then the act is not helpful at all. I guess insurance would rather take the chance that we actually never get the shingles. And have to pay for treatment.
Because this sort of thing can get sticky it is always best to check with your insurer and make sure the doctor is providing services that will be covered by the insurer.
PCPs are not stocking the shingles vaccine so most folks are required to get it at a drug store like CVS or Walgreen. Therefore, the benefit is useless under ACA if it’s mandatory to receive it by your physician during a well check.
I understand what you are saying, but the benefit applies to CVS/Walgreens or another pharmacy. You don’t have to get it from your PCP, but generally I always suggest checking with the insurer and doctor to ensure you know which services are free, which are subject to cost sharing, and which are perhaps not covered.
My doctor prescribed the shingrix vaccine for shingles during my wellness visit (about 1 1/2 months ago). It has not been available at my pharmacy. Will it still be covered whe the vaccine finally comes in? Thank you.
Shingles vaccines are generally covered, however you should always check with your insurer to confirm coverage for a specific drug.
The Shingrix vaccination shingles is a two dose regimen. The second dose must be administered 2 to 6 months after the first. Thus is it impossible for both doses to be administered during your free (annual) preventive care visit.
Nevertheless, the vaccination regimen (i.e. the full vaccination) is covered as a preventive service. See: https://www.healthcare.gov/preventive-care-adults/ for all covered vaccinations, and https://www.vaccines.gov/diseases/shingles for details (including two doses) for the shingles vaccination.
(I’m currently having a dispute with my insurer because it paid for my PCP’s office administering both shots, but paid for only one of the doses. I don’t understand how the insurer can cover “half” of a service.)
Yeah, that is absurd. Clearly that should be covered in terms of pure logic. I would continue to dispute this, you should officially appeal as needed as well https://obamacarefacts.com/appeal-health-insurance-company-or-marketplace-decision/