Does Medicare Cover Pneumonia Shots?

Medicare Part B and Medicare Advantage (Part C) cover the full cost of the pneumonia vaccine if you're 65 or older. It's common to get two shots spaced out by a year, but recommendations depend on your medical history.

You do not need to pay any upfront costs for the pneumonia vaccine. If you have a Medicare Advantage plan, you may have to see an in-network provider to receive a no-cost pneumonia vaccine.

Does Medicare cover pneumonia shots?

Medicare Part B (part of Original Medicare) and all Medicare Advantage plans cover pneumonia shots for those aged 65 and up. Medicare provides certain preventive services completely free of charge.

Examples of Medicare free preventive services

  • Annual checkup
  • Flu shots
  • COVID-19 shots
  • Cardiovascular disease screenings
  • Mammograms
  • Prostate cancer screenings
  • Depression screenings
  • Cervical cancer screenings
  • Diabetes screenings
  • Lung cancer screenings
  • STD screenings
  • HIV screenings
  • Hepatitis B shots
  • Tobacco use counseling
  • Alcohol abuse screenings
  • Nutrition therapy services

You can lower your risk of pneumonia by getting your annual flu shot and by taking advantage of Medicare's free tobacco use counseling services to help you quit smoking.

If you do not have insurance, you can expect to pay between $200 and $250 for a pneumonia shot. The exact price will depend on your provider and the type of vaccine you choose.

How often do we need pneumonia shots?

If you're unsure whether you've had the pneumonia shot before, you should get your vaccine shots a year apart.

Most people 65 or older need two pneumonia shots spaced at least 12 months apart. However, some individuals with diseases such as kidney failure, HIV and certain kinds of cancer might get the second shot in as little as eight weeks.

Make sure your doctor is aware of any serious or chronic medical conditions you have before you get your first pneumonia shot.

You may have received one or more pneumonia shots between ages 19 and 64. For example, if you had certain chronic heart, lung and liver diseases, you may have been vaccinated before the age of 65.

Even if you already had the pneumonia vaccine when you were younger, your doctor may advise you to get the vaccine again after you become eligible for Medicare at age 65.

Where can I get a pneumonia shot?

You can get a pneumonia shot at your doctor's office or your neighborhood pharmacy. A number of large chain stores, such as CVS, Walgreens and Walmart, offer pneumonia vaccines.

Check that your doctor or local pharmacy doesn't charge more than Medicare will pay before you get your vaccine.

What are the differences between pneumonia vaccines?

Different pneumonia vaccines protect against different types of bacteria. According to the Centers for Disease Control and Prevention (CDC), there are four kinds of pneumonia vaccines that can be grouped into two categories.

Types of pneumonia vaccines

  • PCV13
  • PCV15
  • PCV20
  • PPSV23

The number at the end of each name refers to the number of different bacteria types the vaccine protects against. PPSV23 works differently than the other three vaccines and may be better suited for certain types of people including those in poor health. Your doctor or pharmacist will advise you on which shots are right for you.

Side effects are typically limited to soreness and tenderness around the injection site. Headaches and muscle aches are also sometimes reported. In rare cases, PPSV23 may cause more serious problems such as chest pains and heart attacks.

What is Prevnar 13?

Prevnar 13 is the brand name of a popular PCV13 pneumonia vaccine. It prevents 13 different bacterial infections that can cause pneumonia as well as other illnesses, such as meningitis and blood infections.

Prevnar 13 is often given first, and it's followed by Pneumovax 23, which blocks 23 strains of bacterial infections that can cause pneumonia.

Both vaccines are covered by Medicare and many forms of private health insurance.

Prevnar 20 vs. Pneumovax 23

Both Prevnar 20 and Pneumovax 23 are pneumonia vaccines approved by the Food and Drug Administration (FDA). Prevnar 20 protects against slightly fewer bacterial strains compared to Pneumovax 23.

However, clinical trials suggest Prevnar 20 is more effective at protecting against the 19 types of bacteria that overlap between the two. Prevnar 20 may also have longer-lasting protection compared to Pneumovax 23.

Frequently asked questions

Does Medicare cover pneumonia shots?

Yes, both Original Medicare and Medicare Advantage cover pneumonia shots free of charge. You can get two pneumonia shots spaced one year apart without having to pay anything toward your deductible or a copay or coinsurance.

Should I get the pneumonia shot?

You should get the pneumonia shot if you are 65 or older or if you suffer from certain illnesses, such as chronic heart, lung or liver disease. Healthy adults aged 19 to 64 do not typically need to get vaccinated against pneumonia.

What is the average cost of a pneumonia shot?

A pneumonia shot usually costs between $200 and $250 if you pay out of pocket. However, Medicare and most private major medical insurance plans cover the full cost of pneumonia vaccines.

Sources

ValuePenguin used data from the Centers for Disease Control and Prevention (CDC) for the compiling of pneumonia vaccine prices. Medicare coverage information was taken from the Centers for Medicare & Medicaid Services (CMS) and Medicare.gov.

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