Shingles, Seniors & Medicare Coverage

Chances are, most young people have little idea of what Shingles is, much less how doctors treat it, or Medicare covers it. But the skin disease that’s scourge to so many millions of seniors has its roots in childhood. Chickenpox, in fact.

Back in the day as they say, there wasn’t a vaccine preventing most kids from contracting the varicella-zoster virus that causes chickenpox. On the other hand, children traditionally experience a significantly milder version of the virus than adults do. In fact, many parents have breathed a sigh of relief when their little ones presented with the telltale red, itchy spots; relieved to get it over and done with.

Well, there’s over and done with. And then there’s the difficult reality that if you did have chickenpox as a child, your body still hosts the varicella-zoster virus. It hides out in your nerve tissue near the spinal cord, waiting for years. Then, when the immune system of some unsuspecting senior dips low enough, it can reactivate as shingles.

So, What’s Shingles & What Do You Do About It?

While chickenpox is generally not feared, shingles is another story. While not a life-threatening condition, it remains a skin disease dreaded by at-risk seniors. Dreaded, because as anyone who’s suffered through it can tell you, shingles can be extremely painful. Think itchy red rash, fluid-filled blisters, numbness and/or burning in the skin.

The good news is, shingles is preventable for more than 9 out of 10 people, with a new, more effective-than-ever shingles vaccine. And if you do contract shingles, more good news is that it usually goes away on its own after 2-3 weeks.

Getting to your dermatologist’s office in the first 2-3 days of a shingles outbreak can be a huge help. This allows common treatments such as oral antiviral medication, pain relievers and possibly corticosteroids to provide real relief before things get out of hand.

If you’re over 50, certainly if you’re over 60, the shingles vaccine is highly recommended. Good alternative to all the medical care and treatment you’ll need if you do get it. Which raises a question important to so many senior healthcare patients/consumers:

What Will Medicare Cover When It Comes To Shingles?

Medicare Part A covers hospital benefits and Part B covers outpatient benefits. If you develop shingles, your visits to the dermatologist for diagnosis and treatments are covered by Medicare Part B.

After you meet your annual Medicare Part B deductible ($183 in 2018), Medicare pays 80% of the cost of your doctor visits and related lab tests. You’re responsible for the other 20%; unless you purchase “Medigap” coverage to help limit out-of-pocket costs for such deductibles and copayments.

While Part B covers your doctor’s visits related to shingles, the medications for treating and/or preventing shingles are generally going to fall under Medicare Part D coverage.

How can  Medicare Part D Drug Coverage help with Shingles?

Beneficiaries purchase Part D policies from private insurance companies. Some Part D companies include the varicella-zoster vaccine in their drug formularies. When considering aPart D policy, you’ll want to check on that. While this vaccine might cost $200 or more without coverage, beneficiaries with Part D often pay around half that amount when they use their coverage.

For individuals with an active case of shingles, Part D plans should cover a number of medications which help control the infection. Having Part D coverage means you’ll only be responsible for your plan’s required copayment for any of these covered medications instead of full cost.

The most common and least expensive medication is Acyclovir. This medication has been around since the 1980’s and is a generic form of the brand-name antiviral medication called Zovirax.

Your doctor may also prescribe valacyclovir or famciclovir, which are two newer forms of antivirals that may treat shingles more rapidly than acyclovir. That means it’s worth checking for Part D coverage of these drugs too.

Do take note though; many seniors with Medicare Part D Drug coverage still have to confront the infamous  Medicare Part D “Donut Hole” (till 2020). This is an actual reduction in coverage that kicks in for seniors whose drug costs exceed a prescribed monthly and/or annual limit.

For the time being, seniors and their loved ones need to take this and all the other above information into consideration when evaluating the costs and coverages for prevention or treatment of shingles.