Ask the Doctor: Shingles vaccines and Medicare Advantage

Q: I heard there’s a new vaccine for shingles. I’m 55 years old, but my partner is 62 and got the shingles shot last year. I’m confused over what we should do.

A: This is a great question and very much in the news. The FDA approved the new shingles vaccine (Shingrix) in October 2017. The vaccine was recommended by ACIP and approved by the CDC director in February 2018.

The new recommendation is that everyone over 50 years old should receive two doses of Shingrix, 2–6 months apart, regardless of past exposure to shingles or history of Zostavax use. Those who received Zostavax at least two months previously should receive two doses of Shingrix 2–6 months apart.

The Shingrix vaccine is 95 percent effective in preventing shingles. Although it is not a live virus vaccine, it was not studied in HIV patients. Results in HIV patients should be published soon.

So, to answer your question, my recommendation is that you should both receive two doses of Shingrix, 2–6 months apart. Please check with your primary caregiver, as not all insurances have adopted the recommendation and may not be reimbursing for the two-shot series, which costs approximately $270.

Joel Rosenstock, MD, MPH
Chief Medical Officer
AbsoluteCARE Medical Center & Pharmacy

Q: I keep getting mailers from “Medicare Advantage Plans.” What is the difference between Medicare and Medicare Advantage?

A: If you opt to get your coverage through a Medicare Advantage Plan, also known as Medicare Part C, you still have Medicare coverage; however, both your medical and (generally) your prescription benefits will
be contracted through a private company. You may or may not be required to pay an additional premium for your plan. Patients are usually responsible for a set copay for services, rather than a coinsurance. The coverage varies from plan to plan but all Advantage Plans must, at a minimum, cover the same medical and prescription benefits covered by Original Medicare.

It is important to remember that with Advantage Plans, you may be required to choose and stick with a Primary Care Physician. You may also need a referral from your PCP to see a specialist. Provider networks for these plans are more limited than with Original Medicare. You will need to be sure to see providers who are in-network for your plan or you will likely face higher out-of-pocket costs or possibly even no coverage at all.

Bethany Weikart
Care Manager
AbsoluteCARE Medical Center & Pharmacy