Learn if your private insurance will cover ZOSTAVAX.
ZOSTAVAX is covered by many private insurance plans. For some plans, insurance coverage can differ depending on the patient’s age. It’s best to determine your coverage before visiting your health care professional, because he or she may not know the specifics of your plan. By contacting your insurance provider before your appointment, you can get the most accurate information about your plan’s coverage for ZOSTAVAX.
You can also find out more about insurance coverage for ZOSTAVAX by selecting the kind of insurance you have:Private Insurance Medicare
Many private insurance plans cover ZOSTAVAX (Zoster Vaccine Live), and if your health care professional has ZOSTAVAX, he or she may be able to give you the vaccine without requiring an upfront payment from you. It’s a good idea to contact your insurance provider before your appointment and ask about your insurance coverage for ZOSTAVAX so you know what to expect as not all private insurance policies provide coverage for ZOSTAVAX.Find a health care professional near you that may offer ZOSTAVAX.
What you need to know
Most private insurance companies classify ZOSTAVAX as a medical benefit, not a prescription benefit. If your health care professional has ZOSTAVAX, he or she may be able to give it to you just as any other in-office treatment would be given.
If you already paid out-of-pocket for ZOSTAVAX, or your health care professional’s office still requires an upfront payment, you may be eligible for reimbursement under your insurance plan, depending on your coverage, and when and where you were vaccinated. Be sure to call your insurance company for verification. The amount that you are paid by your insurance plan may be less than your upfront payment to your health care professional.
ZOSTAVAX falls under Medicare Part D (not Part B).
Some vaccines can be covered under the medical benefits available through Medicare Part B. But ZOSTAVAX is treated as a prescription benefit by Medicare, which is why it can only be reimbursed under Part D. While ZOSTAVAX can be covered under Medicare Part D, not all people with Part D insurance will receive reimbursement for ZOSTAVAX.
If your health care professional can submit and process a claim for your Medicare Part D plan, he or she may be able to submit your claim directly to the Part D plan on your behalf. However, you will still be responsible for all other costs and co-pays related to your appointment. Your personal insurance coverage can also be impacted by any deductibles, limits and/or co-pays that apply to you.
If your health care professional cannot submit and process a claim for your Medicare Part D plan, and the vaccine is covered, you may be required to make an upfront payment and then submit your claim for reimbursement. Please note that even if you have some coverage for ZOSTAVAX, the amount reimbursed to you by your Part D plan may be less than the amount of your upfront payment. It is a good idea to contact your Medicare Part D plan to learn what coverage is available to you and what process your plan has for submitting a claim.Find a health care professional near you that may offer ZOSTAVAX.
ZOSTAVAX is a vaccine used for adults 50 years of age or older to prevent Shingles (also known as zoster).
Important Safety Information
- ZOSTAVAX does not protect everyone, so some people who get the vaccine may still get Shingles.
- You should not get ZOSTAVAX if you are allergic to any of its ingredients, including gelatin or neomycin, have a weakened immune system, take high doses of steroids, or are pregnant or plan to become pregnant. You should not get ZOSTAVAX to prevent chickenpox.
- Talk to your health care professional if you plan to get ZOSTAVAX (Zoster Vaccine Live) at the same time as PNEUMOVAX®23 (Pneumococcal Vaccine Polyvalent) because it may be better to get these vaccines at least 4 weeks apart.
- Possible side effects include redness, pain, itching, swelling, hard lump, warmth, or bruising at the injection site, as well as headache.
- ZOSTAVAX (Zoster Vaccine Live) contains a weakened chickenpox virus. Tell your health care professional if you will be in close contact with newborn infants, someone who may be pregnant and has not had chickenpox or been vaccinated against chickenpox, or someone who has problems with their immune system. Your health care professional can tell you what situations you may need to avoid.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
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