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UnitedHealthcare Adds Shingrix Vaccine to Preventive Benefits
UnitedHealthcare will include vaccination as a covered preventive service benefit for adults age 50 and over beginning April 1, 2018 with network coverage at no cost .
is paid as a preventive under the medical benefit, not the pharmacy benefit.
The FDA approved the new shingles vaccine,
for the prevention of herpes zoster in adults ages 50 and over on October 20, 2017. The Centers for Disease Control.
and Prevention (CDC) adopted the Advisory Committee on Immunization Practices (ACIP) recommendations on .
What’s a vaccine?
The topic of vaccines always seems to be relevant — and may sometimes be a subject of misinformation. Before vaccines, infectious diseases like smallpox, polio and measles ran rampant.
But thanks to medical advances, there are available vaccines to jump-start our immune system to help protect us. A vaccine is a small dose of germs that’s meant to mimic a certain illness.
This helps your body remember and recognize that infection and helps create antibodies to fight it off — keeping you healthy.2
You know how you may practice something for a long time to get really good at it? Well, a vaccine is kind of like practice for your immune system.
Each time you practice (get a vaccine), your body may get better and better at fighting off that particular strain of illness.
Until one day, your immune system spots that illness and those little antibodies say,
“Put me in coach.” Depending on the illness, you may need a different number of vaccines and timing to prevent illness.
What’s the difference between vaccine and immunization?
There’s a lot of medical terminology out there. And — spoiler alert — many terms may mean the same thing, which is the case here.
A vaccine is something that may fire up your immune system so it can produce immunity to a specific illness. It’s usually given through an injection (like your annual flu shot).
A vaccination or immunization (often used interchangeably) is simply the act of giving a vaccine.
And once you have immunity to a specific illness, you may be protected from getting it even if exposed.2
How does herd immunity work?
Herd immunity is used by the Centers for Disease Control and Prevention (CDC) to describe when enough people within a single community become immune to an infectious disease through.
vaccination or from previous illness.
This may slow the spread of disease and even might make it unlikely to spread at all.3
The percentage of people who may need to have protection in order to achieve herd immunity may vary by disease.
Did you know child vaccines help protect against 16 diseases?5
It’s important to stay on top of your little one’s vaccines, ask any questions you may have and know where to go for more information.
Be sure to schedule regular child well visits starting at birth to keep your child up-to-date on immunizations.
It’s recommended to get a flu shot every year to protect you and your family.6 If you have a UnitedHealthcare health plan, you can get a flu shot at more than 50,000 locations.
COVID-19 vaccines are an important step in slowing the spread of the disease. Review the current information to help you stay informed on COVID-19 vaccines and discuss any questions you may have with your health care provider.
What kind of doctor should I see for my vaccines?
Vaccines can be administered by doctors, nurses and pharmacists. Typically, when you visit your primary care provider for your yearly exam.
your doctor will check your chart to make sure you’re up-to-date on any regularly scheduled vaccines. You may also need to catch up on any doses you may have missed between now .
and your last visit. Making a special trip for flu season? Many walk-in clinics, pharmacies, or even schools will likely offer flu vaccines.7
If you’ve got that next international trip planned, be sure to talk with your doctor about where you’re headed in case you may need a few more vaccines before you hop on the plane.
Review our adult vaccines checklist
You can use this adult vaccines checklist to help prepare for your next doctor visit. Ask your provider which vaccines may be right for you.
Coverage for the Shingles Vaccine
Other common vaccines are covered under Medicare Part B. In other words, you get them in a doctor’s office, then the doctor bills Medicare and—in the case of flu and pneumonia shots—Medicare picks up the full tab.
But the shingles vaccine is covered under the Part D prescription drug program. That means you must be enrolled in a private Part D plan (a stand-alone drug plan or a Medicare health plan that covers drugs), get the vaccine through your plan and pay whatever share of the cost that your plan requires.
You shouldn’t have any problem obtaining the shingles vaccine through your drug plan. Under Medicare regulations, all Part D plans must cover it.
But there are some pitfalls to watch out for in terms of paying for the shingles shot, depending on where you receive it:
If you’re vaccinated at a pharmacy, make sure it’s one that is in your Part D plan’s pharmacy network. Otherwise, the shot will cost you more than the plan’s normal copayment, perhaps even full price. (Every state except Maine allows pharmacists to give vaccinations.)
* If you’re vaccinated in a doctor’s office, make sure the doctor can bill your plan directly through its computer billing process.
or can work through a pharmacy in your plan’s network that can also bill the plan directly. Otherwise, you’ll have to pay the entire bill upfront and then claim reimbursement from your plan.
The bottom line: Call your plan in advance and ask which pharmacies and doctors in your area you should use to receive the shingles vaccine at the plan’s regular copay.
Patricia Barry is a senior editor at the AARP Bulletin.