Medicare Part B will cover you when you visit a dermatologist or other doctor to treat shingles. Medicare prescription drug plans usually cover shingles medications and the shingles vaccine.
However, because prescription plans have different deductibles, pharmacy networks and co-pays, the amount you will pay for shingles treatment can vary greatly.
Having coverage in addition to Traditional Medicare can help you manage the cost of your healthcare. Experiencing shingles can be rough, quality health coverage can mean focusing on your health instead of your bank account.
What is Shingles?
Shingles is a painful skin condition caused by the varicella-zoster virus – the same virus that causes chicken pox. If you had chicken pox as a child, your symptoms probably went away within a week or two.
However, the virus stayed in your nerve tissues. In some people, the virus reactivates in the form of shingles. In fact, you can’t get shingles unless you have had chicken pox.
Shingles is not dangerous, but it is unattractive and painful. And the risk of getting shingles goes up as you age.
If you ever had chicken pox, you probably remember how much it itched. Shingles can itch too, but it is more likely to cause pain.
Here is what to expect, according to the American Academy of Dermatology:
- First, an area of skin on one side of the body will begin burning, itching, tingling or feeling unusually sensitive. This may go on for one to three days, and it may be constant or intermittent.
- Next, a rash develops in this same area. This may be accompanied by a fever, chills or headache.
- The rash then turns into clear blisters. These blisters may last two to three weeks and they are likely to become yellow or bloody before scabbing over.
The blisters are painful. The pain will get better as the blisters heal, but some people continue to have shingles pain for several months.
Prescription anitiviral medications such as famciclovir, valcyclovir and acyclovir can make a shingles episode shorter and less painful. Medications can also help you avoid serious complications of shingles.
One of the most common complications is postherpetic neuralgia, a pain or numbness in the location of the shingles rash that can last for years.
Antiviral medicines work best if they are taken within three days of the start of a shingles outbreak. For this reason, it is important to see a doctor right away if you suspect you have shingles.
Your doctor may also prescribe pain relievers, nerve block injections or coritcosterioid injections. Calamine lotion, ice packs and oatmeal baths can also help relieve the pain and itching.
Shingles itself is not contagious. However, if you have shingles, you can transmit the chicken pox virus to someone who has never had chicken pox or the chicken pox vaccine.
Vaccines for Prevention
A vaccine can reduce your chance of getting shingles, but there’s no vaccine that will prevent all shingles cases. If you have been vaccinated and you get shingles anyway, you are more likely to have a milder case, and you are less likely to develop complications.
There are three vaccination options:
- If you have never had chicken pox, the chicken pox (varicella) vaccine can lessen the chances that you will get chicken pox or, later, shingles.
- The newest shingles vaccine, Shingrix, received FDA approval in 2017. The Centers for Disease Control and Prevention recommends Shingrix for healthy people aged 50 and up. It is given in two doses, six months apart.
- The older shingles vaccine, Zostravax, may also be given in certain cases.
Medicare Part B Coverage for Shingles Treatment
Medicare Part B covers doctor visits and that includes visits to diagnose and treat shingles. Traditional Medicare Part B will pay 80 percent of the doctor’s bill, after you have met your annual deductible ($183 in 2018). You can get additional coverage with a Medicare Supplement (Medigap) plan.
Most Medigap policies will cover the 20% that Original Medicare leaves you responsible to pay. When you have comprehensive coverage, you can get the care you need, when you need it.
If you have a Medicare Advantage plan, your doctor visits will also be covered, but you are usually required to see a doctor within your insurance company’s network. Medicare Advantage policies almost always have a co-payment or coinsurance for a doctor’s visit, talk to your plan about your coverage before you go to the doctors.
Prescription Drug Coverage and Shingles Treatment
To get coverage for shingles medications and vaccines, you must have a Medicare prescription drug plan – either a standalone Medicare Part D plan, or a prescription plan that is part of a Medicare Advantage plan.
Every prescription plan is a little different, but all of them have a “Formulary” or a list of drugs that are covered, along with your copay or coinsurance information.
To find out how much a specific shingles drug or the shingles vaccine will cost you, contact your prescription insurance company. If your policy is with us, contact our Client Service Team and they will be happy to give you all the information you’ll need pertaining to shingles and your coverage.
Most prescription plans also operate with a preferred network of pharmacies. Typically, you will pay less for a medication if you use a network pharmacy.
If you use a pharmacy that is out of network, you could be responsible for the full cost. Contact your provider to find the best pharmacy option in your area.
Medicare coverage that includes a prescription drug plan is an important part of treating and preventing conditions like shingles. At MedicareFAQ, we help you find the coverage that works best for you, with free quotes from the top insurance companies in your area.
To start your quote, give us a call at the number above or fill out our form online by clicking here!
Our Licensed Insurance Brokers are here to help you through the enrollment process, and our Client Service Team will be available for you during the life of your policy. We’re dedicated to ensuring peace of mind when it comes to your health coverage.