Does Medicare Cover Pneumococcal Vaccination?
Medicare covers two pneumococcal vaccinations and an additional single dose which protect against pneumonia. Medicare covers the cost of the first shot anytime you choose to get it after enrolling in Medicare Part B. Medicare covers the second shot so long as you receive it at least one year after your first shot. Confirm with your doctor when you should get your additional pneumococcal shot.
- Written by Terry Turner
Terry Turner
Senior Financial Writer and Financial Wellness Facilitator
Terry Turner has more than 35 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).
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Matt Mauney
Matt Mauney
Financial Editor
Matt Mauney is an award-winning journalist, editor, writer and content strategist with more than 15 years of professional experience working for nationally recognized newspapers and digital brands. He has contributed content for ChicagoTribune.com, LATimes.com, The Hill and the American Cancer Society, and he was part of the Orlando Sentinel digital staff that was named a Pulitzer Prize finalist in 2017.
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Aflak Chowdhury
Aflak Chowdhury
Medicare Expert
Aflak Chowdhury is a Medicare expert and independent insurance broker specializing in group health insurance. He has worked for major providers including Humana and Principal Financial Group and today works mainly in the small group market.
Read More- Published: March 25, 2021
- Updated: May 8, 2023
- 4 min read time
- This page features 9 Cited Research Articles
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Does Medicare Cover the Pneumonia Shot?
Medicare covers the full cost for receiving two different types of pneumonia vaccines — also called pneumococcal vaccines. But the shots have to be given at least a year apart.
- Pneumococcal conjugate vaccine — PCV13 (Prevnar 13)
- Pneumococcal conjugate vaccine — PCV20 (Prevnar 20)
- Pneumococcal polysaccharide vaccine — PPSV23 (Pneumovax 23)
You will pay nothing for the shots so long as you are enrolled in Medicare Part B and the doctor, pharmacist or other qualified health care provider giving the shots accepts the Medicare-approved cost.
Medicare Advantage plans will also cover the cost of both pneumococcal vaccinations. These are private plans that are required to cover everything Medicare Part A and Part B cover.
Your Medicare Advantage plan may also provide more benefits than Original Medicare. Check with your plan administrator to see if you have additional vaccination coverage.
Who Should Get the Pneumonia Shot?
The U.S. Centers for Disease Control and Prevention recommends that everyone over the age of 65 — which includes most Medicare beneficiaries — should get the Pneumovax 23 (PPSV23) vaccine.
- All people age 65 or older
- Cigarette smokers between the ages of 19 through 64
- People between 2 and 64 years old with certain medical conditions (check with your doctor)
The Prevnar 13 (PCV13) vaccine is generally recommended for children younger than 2 years old or for older people with certain medical conditions.
The CDC suggests anyone 65 and older can ask for the Prevnar 13 vaccine if they decide — with their doctor — that it would be beneficial to them.
Who Should Avoid Pneumococcal Vaccinations?
Because of age or certain health conditions, some people should avoid or delay getting a pneumonia shot. This varies based on your situation and the type of vaccine.
- Prevnar 13 (PCV13)
- If you are allergic to any part of the vaccine.
- If you have ever had an allergic reaction to PCV13.
- If you have ever had an allergic reaction to DTaP vaccine or any other vaccine containing diphtheria toxoid.
- If you have already had an earlier pneumococcal vaccine called Prevnar (PCV7).
- Pneumovax 23 (PPSV23)
- If you are allergic to any part of the vaccine.
- If you have had a life-threatening reaction to this vaccine in the past.
If you have a serious illness, you should talk with your doctor about whether it’s safe to get a pneumonia shot or whether you should wait.
What Is the Pneumococcal Vaccine and How Often Should You Get It?
Both pneumococcal vaccines approved for use in the United States protect against multiple types of bacteria that can cause pneumonia. The schedule for taking them depends on your age and medical conditions.
- Pneumovax 23 (PPSV23)
- Pneumovax 23 protects against 23 types of serious pneumococcal bacterial infections. Most adults will need only one shot of PPSV23 in their lifetime. But the CDC recommends up to two additional shots for adults with certain chronic medical conditions.
- Prevnar 13 (PCV13)
- Prevnar 13 protects against the 13 most common types of pneumococcal bacteria that cause the most common serious infections in children and adults. Adults will receive this shot only if they have certain medical conditions and with the advice of their doctor. While children receive seven doses by the time they are 15 months old, adults who get this vaccine will only receive one shot of PCV13 in their lifetime.
- Prevnar 20 (PCV20)
- Prevnar 20 is similar to Prevnar 13, but provides protection against 20 different types of pneumococcal bacteria. It is a more recent addition and Medicare began covering it in October 2021.
How Effective Are Pneumococcal Vaccinations?
While both vaccines work well, neither can prevent all cases. But they can reduce your risk of developing pneumonia.
For every 20 adults who receive a single shot of PPSV23, 10 to 17 will be protected against pneumonia, according to the CDC.
The CDC reports that the effectiveness of the PCV13 shot varies by age for a serious condition called invasive pneumococcal disease (IPD) — a group of pneumococcal bacteria that cause sepsis and meningitis among other conditions.
IPD infects an estimated 35,000 Americans every year and kills about 4,200, according to the CDC.
- Children 2 and Younger
- Eight in 10 protected against invasive pneumococcal disease.
- 65 and Older
- Three in every four protected against invasive pneumococcal disease.
PCV13 was also effective in protecting nine in every 20 adults 65 and older against pneumococcal pneumonia, according to the CDC.
- Association for Financial Counseling & Planning Education (AFCPE®) member
- Holds six Health Literacy certificates from the CDC
- Emmy® Award winner
9 Cited Research Articles
- U.S. Centers for Disease Control and Prevention. (2022, October 5). Reduced Drug Prices, Enhanced Medicare Benefits Under the Inflation Reduction Act Frequently Asked Questions (FAQs). Retrieved from https://www.cms.gov/files/document/10522-external-faqs-about-inflation-reduction-act.pdf
- U.S. Centers for Medicare & Medicaid Services. (2022). Pneumococcal Shots. Retrieved from https://www.medicare.gov/coverage/pneumococcal-shots
- U.S. Centers for Medicare & Medicaid Services. (2020, December 10). Flu and Pneumonia Vaccines: Protect Your Patients. Retrieved from https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-12-10-mlnc#_Toc58396420
- U.S. Centers for Medicare & Medicaid Services. (2020, August 12). Pneumonia Prevention With a Vaccine. Retrieved from https://web.archive.org/web/20210923055923/https://www.medicare.gov/blog/pneumonia-prevention-is-easy-2020
- U.S. Centers for Disease Control and Prevention. (2020, August 7). Pneumococcal Vaccination: What Everyone Should Know. Retrieved from https://www.cdc.gov/vaccines/vpd/pneumo/public/index.html#
- U.S. Centers for Disease Control and Prevention. (2017, March 31). How to Pay for Vaccines. Retrieved from https://www.cdc.gov/vaccines/adults/pay-for-vaccines.html
- U.S. Centers for Disease Control and Prevention. (2017). Invasive Pneumococcal Disease (IPD) (Streptococcus pneumoniae) 2017 Case Definition. Retrieved form https://ndc.services.cdc.gov/case-definitions/invasive-pneumococcal-disease-2017/
- AARP. (n.d.). Does Medicare Pay for the Pneumonia Shot? Retrieved from https://www.aarp.org/health/medicare-qa-tool/does-medicare-cover-a-pneumonia-shot/
- European Centre for Disease Prevention and Control. (n.d.). Disease Factsheet About Pneumococcal Disease. Retrieved from https://www.ecdc.europa.eu/en/pneumococcal-disease/facts
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