Transcript (Shingles and Medicare)

Introduction

Shingles can come on fast and feel intense.

It's a painful skin rash that affects the nerves under the skin.

Most shingles appear as a painful rash on one side of the torso, back, chest, or face.

Anyone who has had chickenpox in the past can develop shingles.

Shingles is common in the United States.

About 1 in 3 people develop it, and adults over 50 have a higher risk.

Medicare can help with prevention, diagnosis, treatment, recovery, and medications. Before we get into shingles coverage, it helps to look at what Medicare covers overall. Part A covers medically necessary inpatient hospital stays and skilled nursing facility care. It also covers hospice and some home health services. Part B includes doctor visits, preventive services, durable medical equipment, and outpatient care. Part D generally covers prescription drugs you get from a pharmacy.

Medicare A, B, C, and D can include co-insurance, co-pays, and deductibles.

In this video, we’ll walk through shingles prevention, diagnosis, treatment, recovery, and medications.

Prevention

Shingles is caused by the reactivation of the chickenpox virus.

Knowing your risks is the key to prevention.

The Centers for Disease Control and Prevention recommends the vaccine Shingrix.

Most adults 50 and older require two doses.

The shingles vaccine is generally covered by Medicare Part D at no cost.

Medicare Part B covers most preventive services, including a Yearly Wellness visit. Those visits may support a shingles prevention plan.

Diagnosis

While doctors often diagnose shingles visually, confirmation may occasionally require lab testing.

Shingles near the eye, face, or in someone immunocompromised needs prompt medical attention.

Early symptoms may include pain, burning, itching, or skin sensitivity before a rash appears. Some people also have fever, headache, chills, fatigue, or an upset stomach.

Medicare Part B covers many diagnostic tests, doctor visits, and outpatient care, subject to a deductible and 20% coinsurance.

Treatment

Treatment often includes antiviral medicine that includes acyclovir, valacyclovir, or famciclovir.

Pain control may include over-the-counter pain relievers, prescription pain medicines, topical treatments, or nerve-pain medicines

Urgent care is needed if shingles affects the eye, and a specialist may be required.

Medicare coverage for inpatient stays begins after you meet the Part A deductible.

The Part A deductible applies per benefit period, not just once each year.

Medicare Part B may cover outpatient shingles care, including doctor visits, urgent care, ER physician services, lab work, imaging, and some durable medical equipment.

Recovery

Follow-up care may be needed if pain continues, sleep is affected, skin becomes infected, or symptoms involve the eye's, face, or hearing. Many people heal within a few weeks, but nerve pain can last longer. Skin infection should also be watched closely.

Recovery support may be needed after major treatment. Part A applies to skilled nursing facilities when certain criteria are met. Skilled nursing care typically requires a three-day inpatient hospital stay first.

Medications

Part D may cover the shingles vaccine and outpatient prescription antivirals.

It may also cover nerve-pain medications.

Medicare Part D usually covers prescriptions obtained at pharmacy.

Prescription drug coverage varies by plan rules, tiers, formulary, and pharmacy network. A formulary is a drug list covered by your Part D plan. A drug may require prior authorization, step therapy and quantity limits. Part B often covers drugs given in medical settings. In most cases, this involves drugs given via injection or infusion, and vaccines for prevention.

Medicare Advantage

Many Medicare Advantage plans include Part D prescription drug coverage. In that case, the shingles vaccine is generally covered at no cost through the plan’s drug benefit, not the medical benefit.

The shingles vaccine is usually easiest to get at an in-network pharmacy that can bill your Part D coverage correctly.

With Medicare Advantage, additional rules come into play. All plans must include Medicare services; however, the guidelines can change. Network use, referrals, and prior authorization may affect access. Medicare Advantage plan rules can also affect costs and timing.

Final Thoughts

Shingles is a nerve-related illness caused by the chickenpox virus reactivating.

With Part D, the shingles vaccine is generally covered at no cost.

Shingles near the eye, face, or in someone immunocompromised needs prompt medical attention.

Clear information, the right care team, and thoughtful use of Medicare can make shingles feel far less overwhelming.