I'll be turning 65 in Feb 2020 and enrolled in Medicare Parts A&B and also the Humana Choice PPO Plan without drug coverage. I want to get?

the Pneumonia shot(s) and I'm wondering if this vaccine is covered either by Part B or the Humana PPO Plan? Thanks

Update:

I've already had the Flu, Tetanus, and both Shingrix vaccines covered 100% by Anthem through the ACA and want to get the Pneumonia vaccine covered either by Medicare Part B or Humana. Will I need to get an Advantage Plan with drug coverage so that the Pneumonia vaccine is covered or will Part B cover the cost?

Update 2:

I'm currently healthy and don't take any prescription drugs but I want to get all of the vaccines that are recommended and that Medicare or a Medicare Advantage Plan will pay for. I'm not getting an Advantage Plan with drug coverage at this time unless I'll need to in order for the vaccines to be covered.

8 Answers

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  • 1 month ago

    The only way to be sure is to CHECK WITH YOUR CARRIERS, Call Medicare and ask them and call your PPO and ask them. YOU should also call your DOCTOR and ask them if it is covered.

  • 1 month ago

    I would consider looking at a Medicare Advantage plan. These include Part D prescription coverage. If you are not currently covered under a prescription plan that meets the requirements of Part D, then you can enroll in Part D. I would not. If you turn 65 in February, you have until the end of May to enroll in B (and D), If you are already collecting SS, enrollment in A is automatic, if not, you need to enroll. And you will be able to change plans mid-year. If you opt for a Medicare Advantage plan upon your enrollment in Medicare, coverage may begin immediately or July 1st, and your existing coverage will stay in place until then.

    Shop around. Make sure you have prescription coverage. No one can answer your question about what will be covered, so ask questions of the plan providers.

  • B
    Lv 7
    1 month ago

    First, you need to get that pneumonia shot, check out the Medicare booklet you got and it is covered under part B.

    Second, what drugs are you taking now? Unless you sign up for a part D plan now, you will be penalized. So sign up, there are some decent plans for those people taking generics common drugs like Wellcare $15.50 a month. But if you have any exotic drug or are diabetic, you will need a heftier and costlier part D plan like United AARP which is close to $70.70 a month. Again, all the costs are in the Medicare booklet you received.

  • Zarnev
    Lv 7
    1 month ago

    Lucy gave you a good answer. Just be aware that if you don't get Part D when first eligible there will be a penalty that you'll pay should you get a plan with Part D in the future unless you currently have creditable coverage such as the VA or Tricare. This penalty will be added on to your premium each month forever. Also, in the future if you don't have Part D don't get sick in the middle of the year since you can't get on a Part D plan until January 1 of each year.

    Edit for your Additional Updates: I'm talking with a client who didn't have drug plan and now wants one because she got sick a few months ago and her particular medication cost $562 per month as opposed to $40 on an Advantage plan. Although that Advantage plan has a $0 copay she has to pay about $49.60 per month in penalties and will have to pay that amount forever. In addition to the penalty she is paying for that drug for 5 months before she can get her plan effective January 1.

    Source(s): Independent Ägent
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  • lucy
    Lv 7
    1 month ago

    You are allowed (2) pneunmonia shots that Medicare will pay for under Part B. I got an email from Medicare reminding me to get one. Just like flu shots, are paid under Medicare. Both times, did not have to submit my Part D insurance to pay for it.

    But for the shingrix vacines (2) are covered under my Part D drug plan. But they are costly, since each shot cost me $167 each. Also, it took me almost a year to get the 2nd shot, since they ran out and (no one) could get any.

    For the Part D, drug plans, the key is (what) drugs are you taking? My 1st year in 2018, got the cheapest and the lowest deductible, since at that time I was on (NO) drugs, so had no idea which plan would be the cheapest or best. But this year developed blood clots, so got Eliquis, a drug thinner that costs about $450 (each) month.

    Now after being on the site for the drug plans and calculating the lowest cost took me a couple of days to figure it out. The (key) is to look at the (annual) drug costs (plus) the yearly monthly (x 12) to find the lowest. In my case, my current plan will be $17.20 per month and the annual cost for my drug is $1,160, but the one I am choosing is $23.50 and the yearly cost is 962.25, so saving about $120 with the change. The difference is that the new plan charges about $20 (less) than the other plans.

    Open enrollment will be on Tuesday, so suggest you go out and look now, so come February will know which Part D plan will work best for you.

  • Eva
    Lv 7
    1 month ago

    Look at the book Medicare will send you and look on Humana's website to see what is covered under your plan. Make sure you sign up for Part D (drug coverage) as well. There's a penalty if you sign up for it later.

  • Anonymous
    1 month ago

    The pnemonia is paid for, but the shingles shots are not. They are very expensive!!!

  • 1 month ago

    Mine was covered 100% between Medicare/Part B & D supplements (sorry, at this point I don't know who paid what . . . but got it from my Doc at my regular check-up and never saw a bill).

    The one that wasn't covered for me was the Shingles shot - cost about $350 - but having friends with that problem I wanted to lower my chances.

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