Chickenpox is a common childhood illness. In fact, 99% of people born in the United States before 1980 have had chickenpox. Once you develop the condition as a child, the virus lies dormant in your body but can reactivate over time, causing shingles. A third of Americans suffer from shingles at some point in their lifetime. As you grow older, the likelihood that you will develop shingles increases. Varicella-zoster is the virus responsible for causing chickenpox. This same virus also causes shingles.
What Are the Symptoms of Shingles?
If you have shingles you may often suffer from multiple uncomfortable symptoms, such as:
- Itchy rashes
- Painful blisters
- Muscle weakness
- Tingling or burning sensations
- Upset stomach
- Fever and chills
- Swollen lymph nodes
- Body aches
Is There a Vaccine for Shingles?
Currently, there is no cure for the disease. However, the FDA has approved a vaccine called Shingrix. Although the vaccine can prevent shingles, it may not alleviate the condition if you already suffer from painful shingles blisters.
Does Medicare Pay for Shingles Shot?
Medicare Part A and Part B do not pay for the shingles vaccine. However, if you have supplemental insurance that covers prescription drugs, the supplement may cover your vaccination.
At this time, Medicare beneficiaries have two options for shingles vaccine coverage:
- They include standalone Medicare Part D and Medicare Advantage plans that offer Part D coverage.
- Part D, which provides prescription drug coverage for Medicare beneficiaries, covers several vaccines, including Shingrix.
- Medicare Advantage plans are comprehensive benefits that pay for all the same things that Original Medicare covers. However, in addition, Medicare Advantage plans offer supplemental coverage for some services that Medicare Part A and Part B do not cover.
- Some Medicare Advantage plans include prescription drug coverage that pays for the shingles vaccine.
Should Medicare Beneficiaries Get the Shingles Vaccine?
Because shingles occurs so frequently in those who are aged 50 or older, the Centers for Disease Control (CDC) suggests a vaccine for everyone within that age range. Without the vaccine, those of advanced age would remain susceptible to a shingles outbreak.
If you have a weak or compromised immune system, you may be even more prone to developing shingles. Your immune system may be in a weakened state due to:
- An active infection.
- Diseases that involve the immune system, such as human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS).
- Medications that suppress your immune system.
Shingles is a painful condition that should be avoided if possible. If you develop shingles, you can expect a rash to appear on your abdomen, chest, or face. The rash may initially feel itchy or tingly, but the discomfort from the breakout progresses to pain as blisters form. The blisters typically develop scabs after a week or so and resolve within about a month.
How Effective Is the Vaccine at Preventing Shingles?
Shingrix is given in a two-dose series and has varying degrees of effectiveness based on the age of the patient. Clinical trials show:
- 96.6% effectiveness if you are in your 50s.
- 97.4% effectiveness if you are in your 60s.
- 91.3% effectiveness if you are aged 70 or older.
After your vaccination, your protection level against developing shingles remains at 85% for up to four years following the shot.
Is Shingles Contagious?
Shingles is not contagious, but if you have the condition, you can pass the varicella-zoster virus that causes shingles on to someone else. The spread occurs when another person comes into direct contact with the liquid that oozes from the shingles blisters. If a person who has never had chickenpox or received the chickenpox vaccine encounters the varicella-zoster virus, they develop chickenpox.
To pass the virus on to someone else, the person suffering from shingles must have an active infection with the blisters present. You cannot pass the shingles virus to another person prior to the appearance of the blisters or after they form scabs. In addition, even if you have a blistering rash, you are unlikely to spread the varicella-zoster virus if you keep the blisters covered.
Are There Long-Term Risks Associated with Shingles?
When a shingles rash appears, the blisters present along the pathway of a nerve that has become infected. Sometimes, the shingles virus can cause lasting damage to those nerve fibers. As a result, you may suffer from debilitating pain even after the rash has disappeared. The pain may last for several months, or in some cases, years.
- Postherpetic Neuralgia (PHN): The nerve pain that results from shingles is called postherpetic neuralgia (PHN), and up to 18% who have had shingles develop the condition. The discomfort associated with PHN is usually described as weakness at the site of the shingles rash or stabbing and throbbing pain in the area. Your risk of developing PHN with shingles increases as you grow older. Additionally, the duration and severity of the pain are greater for seniors.
- Serious Complications from Shingles: Although serious complications, hospitalizations, and deaths are rare for shingles sufferers, they can occur, especially in those who are elderly or have a compromised immune system. In rare instances, individuals with shingles may develop blindness, auditory impairments, brain inflammation, or pneumonia. Moreover, up to 4% of shingles patients require hospitalization. Nevertheless, fewer than 100 people die of shingles each year.
Can You Get Shingles Twice?
You can develop shingles multiple times. The odds of you getting a new case of shingles within seven years of the first occurrence is almost 5%. Still, even though it is possible to have the condition more than once, you are unlikely to experience more than one instance of shingles in your lifetime.
Who Administers Shingles Vaccines?
Your doctor’s office or a local pharmacy may administer your shingles vaccine. Keep in mind that you must have a prescription from your doctor to receive a vaccine from a pharmacist.
Medicare Part D plans include a network of pharmacies. If you have Part D, to ensure that your shingles vaccine is covered, be sure to visit a pharmacy that participates in your Part D network. If you visit a participating pharmacy, you will only be responsible for your copay.
How Much Do Beneficiaries with Part D Coverage Have to Pay for the Shingles Vaccine?
Medicare beneficiaries with Part D coverage can expect to pay about $50 for each shot in the two-shot series. This is a significant saving compared to the average retail price, which is currently $207.86.
It is important to note that the actual cost of your vaccine may vary based on the Part C or Part D coverage that you select and the place where you receive the vaccine.
For more information visit Medicare Part D Coverage.
Is Additional Assistance Available if You Are Unable to Afford the Shingles Vaccine?
Some beneficiaries may find the cost of the shingles vaccine unaffordable. GlaxoSmithKline, the manufacturer of the Shingrix vaccine, has created a patient assistance program to help defer some of the out-of-pocket expenses associated with receiving the shot. If you have Medicare Part D, to qualify for the assistance program, you must have already spent $600 or more on prescription medications through your prescription drug plan.