Medicare patients stuck footing the bill for vaccine

Health officials have urged Medicare patients to get a whooping cough shot — part of the effort to slow the spread of a disease that has been declared an epidemic in Washington.

Some of those patients who have gone to a health clinic to get immunized were in for a surprise. In-clinic shots are not covered by Medicare, because they are covered under its prescription drug program. Many of the county’s 82,000 Medicare patients have to go to a pharmacy to get the shot.

“This is really unfortunate, a true barrier to encouraging people to get vaccinated,” said Dr. Gary Goldbaum, health officer for the Snohomish Health District.

Since January, whooping cough has sickened nearly 2,000 people statewide, a more than 10-fold increase over the 154 reported in the first five months of last year.

In Snohomish County, 340 cases have been reported so far this year, far exceeding the 225 cases reported last year.

The Everett Clinic became aware of the issue with Medicare patients getting the shot last month. Patients called to complain that they had been billed for a shot they thought would be covered through Medicare.

“It’s not very patient-friendly for someone who says, ‘I have a grandkid and need a shot’,” said Dr. Yuan-Po Tu, who oversees The Everett Clinic’s walk-in clinics.

The shot protects against whooping cough, also known as pertussis, as well as diphtheria and tetanus.

It may seem confusing for Medicare patients to be able to get some shots at their doctor’s offices, and not others, said Sandi Peck, a spokeswoman with the state Insurance Commissioner’s office.

Medicare patients should either call the health plan that covers their prescription drugs or their Medicare Advantage plan for more details on getting the whooping cough shot, she said.

Although the shot is recommended for all children and adults, health officials have urged older adults who may be caring for infant grandchildren to get immunized.

Infants are particularly vulnerable to the disease. They can’t get their first whooping cough shots until they’re about two months old. Whooping cough can cause a number of problems in infants, including pneumonia, seizures and trouble breathing.

Five immunizations are recommended for children by the time they are age seven.

In adults, whooping cough symptoms, such as a runny nose, mimic that of a common cold, Tu said. “If taking care of an infant, they can transmit that and it can be a fatal infection in infants,” he said.

Area clinics are directing Medicare patients, those 65 and up, to a nearby pharmacy to get the shot. Medicare patients are advised to call ahead for specifics on costs and whether someone is on-hand to administer the shot.

Some area pharmacies are working with the Snohomish Health District to provide low cost shots to low-income adults.

In some cases, clinics will provide the shot to Medicare patients during a medical appointment, but they are warned that they will be charged.

If a patient doesn’t want to make an extra stop to get the shot, the clinic will offer the immunization for an out-of-pocket charge of about $60, said Marcy Shimada, chief executive at Edmonds Family Medicine.

The clinic is preparing a handout to explain the options Medicare patients have to get the shot.

“What we found by calling around to various pharmacies was that really the patient could get a pretty good deal at the pharmacy and have their Medicare coverage,” Shimada said.

Medicare patients may still have a co-pay when getting the immunization at a pharmacy. “It varies by plan,” said Fran Daoust, the clinic’s patient services director.

The Everett Clinic has a similar policy. Medicare patients generally would pay $109 for the immunization. It’s discounted to $62 if they pay the day they are immunized.

The Community Health Center of Snohomish County charges Medicare patients $60 for the shot but low-income patients may qualify for a discount, said LuAnne Kay, spokeswoman for the nonprofit health care organization.

Sharon Salyer: 425-339-3486; salyer@heraldnet.com.

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