People with weaker immune systems, such as young children and elderly people, are at a higher risk of getting pneumonia. If left untreated, pneumonia can be a serious condition.
It is also easily transmissible through coughing, sneezing, and even touching an infected surface. One of the best ways to prevent pneumonia is through getting a pneumonia vaccine.
So a common question many people have is, “does Medicare cover pneumonia shots?” In this article, we answer that question in clear, plain English. You will also find the average costs of pneumonia vaccines and other helpful info.
Does Medicare Cover Pneumonia Shots?
The short answer is yes; Medicare will cover the cost of administration of pneumonia vaccines. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your administration of pneumonia vaccines. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for pneumonia vaccines. Coverage for pneumonia vaccine administration is provided by Medicare Part B.
Most of the time, it is Medicare Part D that provides coverage for preventive vaccines. Medicare Part D plans are a separate part of Medicare that provides coverage for prescription medications and vaccinations. However, Medicare Part B provides coverage for some vaccines including the two types of pneumonia vaccines.
Medicare Part B covers 100 percent of the costs of pneumonia vaccines if you received them from a provider that accepts Medicare assignment. Providers who accept Medicare assignment agree to the Medicare-approved prices, which are usually lower than the regular cost.
Part C Coverage for Pneumonia Shots
Medicare Advantage plans (Medicare Part C) also provide coverage for pneumonia vaccines. They cover everything Original Medicare covers, as well as offer some additional benefits. However, exactly what it covers and what your out-of-pocket costs are will vary depending on the specifics of your plan.
How Much Do Pneumonia Vaccines Cost?
A single dose of Pneumovax 23 costs around $135. On the other hand, a single dose of Prevnar 13 costs around $250.
What Are The Two Types Of Pneumonia Vaccines And What Are Their Differences?
There are two types of pneumonia vaccines and those are pneumococcal conjugate vaccine, or Prevnar 13, and pneumococcal polysaccharide, or Pneumovax 23.
Prevnar 13 boosts the immune system, allowing the body to protect itself from 13 strains of Streptococcus pneumoniae, a bacteria that causes pneumonia. On the other hand, Pneumovax 23 protects you from 23 strains of Streptococcus pneumoniae.
Prevnar 13 is not necessarily administered to you unless your healthcare provider decides that it is necessary to reduce your risk of getting infected. On the other hand, Pneumovax 23 is the preferred vaccine to be administered to people ages 65 or older.
If you receive a Prevnar 13, you may get administered with a Pneumovax 23 1 year later.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover tooth extractions?