Michelle Andrews answers questions about insurance and the Affordable Care Act

Many readers have contacted me about health insurance and the Affordable Care Act. Here are answers to some of their questions.

Q. I have Medicare and a Plan F Medigap plan, so I should be covered for all medical needs. But in order to get the shingles vaccination, it will cost me $185. I can’t pay this without using my grocery or prescription money. It’s totally unfair. What can I do?

A. Shingles is a painful rash caused by a virus that can lead to long-term nerve damage called postherpetic neuralgia. All Medicare Part D prescription drug plans cover the shingles vaccine, which is recommended by the Centers for Disease Control and Prevention for people age 60 and older. But Medigap plans, which may cover the deductible and coinsurance amounts for services provided under Medicare Parts A and B (hospitalization and outpatient care), don’t offer any financial help on the co-payments for vaccines and other drugs covered under Part D.

A Government Accountability Office report published in December found that seniors faced many obstacles to getting needed vaccines, including the shingles vaccine. Many physicians don’t recommend or even stock the shingles vaccine, the report found. The amount that the patient pays out of pocket for that vaccine could also be a barrier, according to the report.

If the only health coverage you have is through Medicare and your Medigap plan, there are still ways you may be able to reduce your co-payment for the vaccine, says David Lipschutz, a policy attorney at the Center for Medicare Advocacy in Washington.

First, if you have Part D coverage, contact your plan to make sure the co-payment you’re being quoted is accurate.

In addition, many doctors who don’t stock the vaccine ask patients to buy it from the pharmacy. If that’s the case, make sure the pharmacy is in your plan’s network so you’ll owe a smaller co-payment than if you buy the vaccine from an out-of-network pharmacy, Lipschutz says.

If the vaccine co-payment is still too high, it may be worth looking into other Part D plans or signing up for one during the upcoming annual enrollment period, Oct. 15 to Dec. 7. Depending on your other prescription drug needs and coverage, you may be able to find a better deal, Lipschutz says.

It’s worth noting that under the Affordable Care Act, people who have new private health insurance plans and those whose plan benefits have changed significantly are eligible to receive, free of charge, vaccines recommended by the CDC’s Advisory Committee on Immunization Practices. Plan members who are in their early 60s, therefore, might qualify for a shingles vaccine without a co-pay.

Q. Do I have to keep my 18-year-old child on my health insurance?

A. In a word, no. The Affordable Care Act requires insurers to offer to cover adult children of policyholders until age 26, but it doesn’t require parents to purchase that coverage, according to an official at the Department of Health and Human Services.

Requiring parents to purchase coverage might not be affordable for everyone. Many employers are increasing the cost of dependent coverage, say experts. In addition, “if you have a sick child, that could significantly increase your premium,” depending on your plan, says Timothy Jost, a law professor at Washington and Lee University who has written extensively about implementation of the health law. The situation will change in 2014, when health plans will no longer be able to charge people more for coverage if they’re sick.