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WARNING about Tricare for Life coverage and the Shingrix shots

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November 21, 2020, 09:48 PM
bald1
WARNING about Tricare for Life coverage and the Shingrix shots
Word to the wise military retirees on Tricare For Life!

Got a bill from my doctor today for >$150 for the Shingrix #1 shot.

I'm on Medicare B and Tricare For Life.

Found this utter bullshit which REALLY pisses me off as I had no advance knowledge:

"TFL covers the shingles shot as a medical coverage, not pharmacy coverage. So, the process goes like this:

You get the shingles shot.
You do not have Part D Medicare, so the cost falls to TFL.
TFL covers the shot as a medical cost not covered by Medicare.
When medical costs are not covered by Medicare, TFL deductibles and cost-shares apply.
The deductible is $150 single/$300 family rates, with a $30 cost share for a network primary care doctor.

The bottom line is, you pay for the shot even though it is technically covered.

That explains the medical coverage-side of TFL, however, on the pharmacy side of TFL, you can get the shot at a Tricare network pharmacy. Use the Tricare pharmacy coverage and the shot is covered 100%."

So now I'm trying to find a local Network Pharmacy that gives these to arrange my follow up #2 Shingrix shot.



Certifiable member of the gun toting, septuagenarian, bucket list workin', crazed retiree, bald is beautiful club!
USN (RET), COTEP #192
November 22, 2020, 03:40 AM
ZSMICHAEL
Tricare can be tricky. They are supposed to be paying 100 percent for Telehealth but are taking off a copay. They are promising to fix the problem but continue to take off a copay. Medicare can be tricky with vaccines. Still I would pay 150 dollars to avoid Shingles. Thanks for the heads up.
November 22, 2020, 09:30 AM
229DAK
quote:
So now I'm trying to find a local Network Pharmacy that gives these to arrange my follow up #2 Shingrix shot.
Please let us know what you find out.


_________________________________________________________________________
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NRA Pistol Instructor
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The afternoon knows what the morning never suspected.
-- Robert Frost
November 22, 2020, 09:46 AM
bald1
quote:
Originally posted by 229DAK:
quote:
So now I'm trying to find a local Network Pharmacy that gives these to arrange my follow up #2 Shingrix shot.
Please let us know what you find out.


I've found two local pharmacies. :thumbsup:


https://www.tricare.mil/Covere...ered/ShinglesVaccine

Getting Vaccines at TRICARE Network Pharmacies:

You can get the shingles vaccine for free at a participating network pharmacy. You can find a pharmacy by:

Calling 1-877-363-1303
Using the Express Scripts Mobile App
Searching online



Certifiable member of the gun toting, septuagenarian, bucket list workin', crazed retiree, bald is beautiful club!
USN (RET), COTEP #192
November 22, 2020, 11:59 AM
REdwin89
I was told both shots go to your pharmacy. You get the first and they keep the second for you till after the waiting period. Hope that's not true in your case.


________________________________________________
"Things are more the way they are today than they've ever been before"

"I don't know a lot but I can zero beat the V's on an R390."

November 22, 2020, 12:30 PM
LimaCharlie
My wife and I got the Shingrix shots at the Safeway pharmacy for free under Tricare. We each got a 10% off our next shopping trip coupon. Two shots each with a total of four coupons.


U.S. Army, Retired
November 22, 2020, 07:16 PM
bald1
For those of you who got your Shingrix shots at a pharmacy, did you need a prescription from your internist?

Had to ask as I'm new to this kind of thing (despite my advanced age Big Grin ).



Certifiable member of the gun toting, septuagenarian, bucket list workin', crazed retiree, bald is beautiful club!
USN (RET), COTEP #192
November 22, 2020, 07:36 PM
Bassamatic
Sounds like they have a deductible...just like Medicare does.



.....never marry a woman who is mean to your waitress.
November 22, 2020, 07:52 PM
arfmel
quote:
Originally posted by bald1:
For those of you who got your Shingrix shots at a pharmacy, did you need a prescription from your internist?

Had to ask as I'm new to this kind of thing (despite my advanced age Big Grin ).


I had my Shingrix shots at an independent pharmacy and paid out of pocket, but no prescription was needed. Wife says she got hers at Walgreens snd doesn’t remember needing a prescription, either.






November 23, 2020, 01:24 PM
ZSMICHAEL
No prescrition is needed for the vaccine. You may have to complete a questionnaire at the pharmacy.
November 23, 2020, 04:33 PM
m_miller
I am on Medicare and Tricare for life also. Last year I got both shingrix shots at the local Walmart pharmacy as my local doctor didn't have it at the time. I have never been billed for any copays in over 12 months. Maybe you can check your local Walmart for the shot. All of this healthcare insurance BS is too f*cking complicated and confusing. No RX was required. Thanks for the heads up as I need a tetanus shot too.
November 23, 2020, 04:53 PM
Ronin101
i called my insurance provider today. They cover Shingrex and cologuard if you are fifty or older. wich I am so I am getting my first shot tomorrow
November 23, 2020, 07:52 PM
Sigmund
Another Medicare and TriCare for Lifer. We both got two Shingrix shots at the pharmacy in our supermarket (HyVee) and did not pay a thing.

With those two plans (and meds at the nearby military clinic) we rarely pay anything. It's way too complicated for me, Mrs. Sigmund handles that stuff.
November 24, 2020, 05:56 AM
nmsigshooter
In 6 months I will be in the same boat. I got the older shingles shot years ago and really don't want the new one. I already have headaches with Tricare Prime, can't wait for TFL. I hate having to deal with the military for anything, its a cluster!
November 24, 2020, 06:07 AM
steeve555
Although I have Tricare for life I got mine at the VA.
November 24, 2020, 08:55 AM
SBrooks
Blue Cross paid for both my shots with no prescription and minimal copay/out-of-pocket. Just walked into CVS and asked for it...


------------------
SBrooks
November 24, 2020, 09:52 AM
mas4363
I got both of my shingles shots at the Youngstown Ohio VA Outpatient center with no cost to me.



Sgt. USMC 1970 - 1973