Does Medicare Cover Pneumonia Shots?
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Original Medicare (Parts A and B) and Medicare Advantage (Part C) cover the full cost of the pneumonia vaccine if you're 65 or older. If you're under the age of 65, you may get a free pneumonia vaccine only if you have a certain condition, such as heart or liver disease.
If you have a Medicare Advantage plan, you may have to see a doctor in your network to get a free pneumonia shot.
Does Medicare cover pneumonia shots?
Medicare Part B (part of Original Medicare) and all Medicare Advantage plans cover the full cost of pneumonia shots.
Medicare covers the full cost of your pneumonia shot even if you haven't met your deductible. You also don't need to make a copayment or pay coinsurance for a pneumonia vaccine because it counts as a preventive service.
Keep in mind that Medicare Advantage plans may require that you see an in-network doctor to get a free pneumonia shot. If you have Original Medicare, you may want to check that your doctor accepts the prices set by Medicare, called accepting assignment.
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.
How often do you need pneumonia shots?
You should get your vaccine shots a year apart if you don't know whether you've had the pneumonia vaccine before.
Most people 65 or older need two pneumonia shots spaced at least 12 months apart. But some people with diseases such as kidney failure, HIV and certain kinds of cancer might get the second shot after eight weeks.
Make sure your doctor knows about any serious or ongoing medical conditions you have before you get your first pneumonia shot.
You may have gotten one or more pneumonia shots between ages 19 and 64. For example, you probably got vaccinated before the age of 65 if you had certain types of heart, lung or liver disease.
Even if you already had the pneumonia vaccine when you were younger, your doctor may tell you to get the vaccine again after you become eligible for Medicare at age 65.
How much does a pneumonia shot cost without insurance?
A pneumonia shot usually costs between $117 and $288 per shot if you don't have insurance. The cost of a pneumonia shot without insurance depends mainly on what type of shot you get.
Pneumovax 23 costs less per dose than Prevnar 20. But you should ask your doctor what type of pneumonia vaccine is best for you before you get a shot.
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.
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 fall into two categories.
Types of pneumonia vaccines
- PCV15
- PCV20
- PCV21
- PPSV23
The number at the end of each name refers to the number of different bacteria types the vaccine protects against. Your doctor or pharmacist will tell you which pneumonia shot you should take.
Side effects typically include soreness and tenderness around the injection site. Some people also report headaches and muscle aches.
Does Medicare cover Prevnar 20 and Pneumovax 23?
Yes, Medicare covers Prevnar 20 and Pneumovax 23.
The Food and Drug Administration (FDA) approved both Prevnar 20 and Pneumovax 23 as pneumonia vaccines. Prevnar 20 protects against slightly fewer bacterial strains compared to Pneumovax 23.
If you get Pneumovax 23, you may need to first get a dose of PCV15 one year beforehand.
Frequently asked questions
Does Medicare cover pneumonia shots?
Yes, Original Medicare and Medicare Advantage both cover the full cost of pneumonia shots. You can get two pneumonia shots spaced one year apart without having to pay anything toward your deductible or a copay or coinsurance.
Who can get the pneumonia vaccine?
Those aged 65 or older, and people suffering from certain illnesses, such as chronic heart, lung or liver disease, should get the pneumonia vaccine. Healthy adults aged 19 to 64 do not typically need to get pneumonia shots.
Is the pneumonia vaccine free for people over 65?
Yes, the pneumonia vaccine is free for people over 65 who have Original Medicare (Parts A and B) or Medicare Advantage. If you have Medicare Advantage, you may need to see an in-network doctor to avoid paying extra costs.
Sources
ValuePenguin used data from the Centers for Disease Control and Prevention (CDC) to find pneumonia vaccine prices. Medicare coverage information was taken from the Centers for Medicare & Medicaid Services (CMS) and Medicare.gov.
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