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Ilsa

(61,633 posts)
Thu Oct 5, 2023, 10:05 PM Oct 2023

So the drug company Glaxo Smith Klein or Pfizer (or both?) has been pushing

their RSV vaccines for seniors over 60 years old, particularly if they have any form of COPD. Problem is, only Medicare Part D (Advantage) pays for it, as far as I can tell, and I don't have Part D. The vaccine can cost as much as $330 at a pharmacy, doctors' office, or County Health Dept.

I have a supplemental policy, but I haven't found out yet if they cover any or all of it.

Anyone know a way to get the vax cheaply?

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Maru Kitteh

(28,299 posts)
1. Such absolute crap. An intelligent government would provide ALL vaccines free.
Thu Oct 5, 2023, 10:14 PM
Oct 2023

It's so much cheaper than serious illness!


So have you spoken to your county health department specifically? They may have helpful ideas or services.





Ilsa

(61,633 posts)
4. Yes, but they haven't been much help.
Thu Oct 5, 2023, 10:30 PM
Oct 2023

My dr's office didn't purchase the vaccine, so they didn't give it in the office. Probably not many opting for it.

Maru Kitteh

(28,299 posts)
6. I found this:
Thu Oct 5, 2023, 10:48 PM
Oct 2023

Pfizer RxPathways® connects eligible patients to assistance programs that offer insurance support, co-pay assistance, and medicines for free or at a savings.


Learn more by visiting www.PfizerRxPathways.com
or calling 1-844-989-PATH (7284).

https://www.abrysvo.com/savings-and-support


------------------


It's worth a shot Good luck!

Ms. Toad

(33,784 posts)
10. I don't know about this one,
Thu Oct 5, 2023, 11:19 PM
Oct 2023

But most expressly exclude folks on Medicare. (I did a lot of research for a friend on a very expensive medication - it was quite discussing. The medication put her on the donut hole, and programs like this one would provide it for a $25 copay for anyone with insurance - except Medicare. My spouse has a similar issue with one of her medications.

brewens

(13,219 posts)
2. I was going to check into that tomorrow. I have Medicare and a drug plan. My COVID and flu
Thu Oct 5, 2023, 10:19 PM
Oct 2023

shots yesterday were no charge.

Ilsa

(61,633 posts)
5. my flu shot was covered at the health dept last week.
Thu Oct 5, 2023, 10:32 PM
Oct 2023

They billed Medicare for it. They refuse to bill my supplemental insurance (if they cover it).

Ms. Toad

(33,784 posts)
11. Influenza is covered under part B.
Thu Oct 5, 2023, 11:29 PM
Oct 2023

There should be no copay (and no need to submit it to your supplemental)

yonder

(9,610 posts)
7. A local College or University might have
Thu Oct 5, 2023, 11:02 PM
Oct 2023

a student health program that can extend into their surrounding community at large. In our area that is an option for the new Covid vax but limited to certain days.

Maybe worth a shot?

Edit: no pun intended


MiniMe

(21,645 posts)
8. My Covid, flu, and RSV vacs were covered for me, but I have Part D
Thu Oct 5, 2023, 11:10 PM
Oct 2023

I almost have to have Part D, my medications are expensive.

Ms. Toad

(33,784 posts)
9. So part D is where Medicare covers the RSV vaccine.
Thu Oct 5, 2023, 11:10 PM
Oct 2023

(Some vaccines are covered by part B, others are covered by Part D.)

I'd suggest biting the bullet and looking into buying a part D plan. Since you apparently didn't buy one when you were first eligible, you'll have a lifelong penalty. Depending on how late your purchase is, it might still be worth it. The monthly penalty for 2023 is $ .3274 x the number of months you were late enrolling.

As long as we're stuck with an insurance model I agree, in principle, with a penalty for failing to enroll because at the time you don't need prescription coverage. If only sick people buy insurance, the cost of insurance will be priced out of range for everyone.

That said, this penalty is exorbitant. If my parents had enrolled late, and just now wanted to enroll (at age 91+) they would have to pay a monthly penalty of about $102/month - on top of the cost of the plan. My plan costs about $8 this year. If I stick with the same plan next year it is free. And messaging about the penalty is really bad. I know some very smart people who are paying a lifetime penalty because they didn't understand the rules.

But even more than making the penalty reasonable, we need to ditch the insurance model for health care.

Ilsa

(61,633 posts)
12. I have a Supplemental Plan, but it doesn't cover 100%
Fri Oct 6, 2023, 11:48 AM
Oct 2023

of Rx's (I have small copays).

My penalty would be relatively small. But I didn't buy the Advantage plan due to limitations explained by the agent last year. About half choose Part Advantage plans, others choose a supplemental. I'm guessing that the RSV vaccine will be covered in a year or so under Part B, like the flu vax is.

Ms. Toad

(33,784 posts)
15. A supplement plan doesn't cover prescriptions.
Fri Oct 6, 2023, 02:50 PM
Oct 2023

Supplemental plans (medigap) plans covers part of the 20% of medical (not drug) costs that Medicare doesn't cover.

For prescription coverage you need a stand-alone part D plan, OR a Medicare advantage plan that includes drug coverage.

The law requires Medicare to cover RSV (and other CDC recommended vaccines) 100%. So RSV is covered 100% now.

The catch is that a few vaccines are considered medical (covered by original Medicare), and most are considered drugs (covered by part D).

You made a good choice to skip Medicare Advantage plans. But you need a separate part D plan. If you ever need expensive prescriptions you won't be able to get coverage without a part D plan.

If you have prescription coverage (part D), go back and ask the pharmacy to explain why it isn't following the law about coverage of CDC recommended vaccines (100% covered at an in-network pharmacy). If you don't, consider buying the cheapest plan available now to stop the penalty clock from ticking. A few bucks a month is worth the added vaccine coverage (shingles, RSV, tetanus, hepatitis, even if it covers nothing else) - not to mention making sure you can actually buy a plan when you need one without a massive penalty. My plan is free next year (it's been about $8); my spouses is a bit more - about $10/month - I don't know next years price.

Ilsa

(61,633 posts)
20. Thank you so much. Part D has me confused
Sat Oct 7, 2023, 03:08 AM
Oct 2023

because every time I try to read up on it, it also was about Med Advantage. Right now, the penalty will be very, very low.

Ms. Toad

(33,784 posts)
21. They don't make it easy!
Sat Oct 7, 2023, 05:59 AM
Oct 2023

You can look for plans here: https://www.medicare.gov/plan-compare/#/?year=2024&lang=en

If you create an account and log in you will be able to create and save a drug list so you don't have to type it in again every time you want to compare overall cost estimates (premium + estimated drug costs for the year).

karynnj

(59,418 posts)
13. Medicare part d is the drug plan, MA is part C.
Fri Oct 6, 2023, 11:51 AM
Oct 2023

I think every part D plan is different with a different list of drugs covered. Each MA plan is different as well.

Ms. Toad

(33,784 posts)
16. All are required to cover CDC recommended vaccines with $0 copay.
Fri Oct 6, 2023, 02:58 PM
Oct 2023

They can impose network restrictions (like getting them at a specific pharmacy), but they are 100% covered as of 1/2023.

A few are covered under Part B (pneumonia, COVID 19, influenza, and hepatitis B). The rest are covered under Part D.

Here's some information about how the coverage works (including 2023 changes).

Delphinus

(11,766 posts)
17. Thank you
Fri Oct 6, 2023, 03:04 PM
Oct 2023

That is good information.

I am new to Medicare (have Parts A & B, with a Part D through somewhere and Part G, High Deductible plan) and I find all of this so confusing. I vote Medicare for All and no more advantage plans.

Ms. Toad

(33,784 posts)
18. Find your part D (prescription) coverage -
Fri Oct 6, 2023, 03:26 PM
Oct 2023

That's where you'll get your free RSV vaccine.

Another tip on part D plans (and actually most insurance coverage for drugs) - you can often save big bucks on prescription coverage by buying a lot of your medicines through Costco mail order or Good Rx (and just skipping the insurance). It's bizzrre, but a little more than half of our drugs are cheaper without insurance through Costco mail order. It does make it more complicated, since you have to track the out-of-pocket costs against the insurance costs. The savings more than covers the cost of membership - so even if we didn't have a costco nearby we'd still have a membership. For example, potassium citrate costs from $144.50 to $1407 for a 3 month supply, depending on which plan we bought. Without insurance, it costs $244.78 from Costco. All of the plans that sell it for under $245 were very pricey plans $65/month or more. So we bought the ~$10/month plan (with Potassium Citrate for around $444/90 days) - and buy the med from Costco.

We compared all plans - and found that the plans with the cheapest premiums still ended up being cheaper than the ones with higher premiums (as long as we shopped around for cheaper off-plan drugs).

A HERETIC I AM

(24,285 posts)
14. I got it at my Walgreens recently and ....
Fri Oct 6, 2023, 11:56 AM
Oct 2023

Now I'm homeless.


Kidding.

I got 4 shots about 2 weeks ago, 2 in each arm.

The most recent COVID shot
The RSV vaccine
The Flu shot and
The Pneumonia shot.

No copays, no nothing.

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