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Pneumonia is a serious medical condition. Especially for people who have weaker immune systems, such as children and seniors. This illness can have a big impact on their lives. So it is important for people to be vaccinated to protect themselves against pneumonia.
So a common question many people have is, “does Medicare cover pneumonia vaccines?” 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 Vaccines?
The short answer is yes; Medicare will cover the cost of the 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.
Even though coverage for preventive vaccines is mostly provided by Medicare Part D, Medicare Part B still covers some vaccines. Preventive vaccines covered by Medicare Part B include the following:
- The aforementioned pneumonia vaccines
- Flu vaccines
- Hepatitis B vaccines
There are two types of pneumonia vaccines that we’ll discuss later and Medicare Part B provides coverage for both.
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 of Pneumonia Vaccines
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 you’ll pay out of pocket will vary depending on the specifics of your plan.
That said, because Medicare Part C plans must provide coverage for everything Original Medicare covers, all Part C plans cover 100 percent of the costs of pneumonia vaccines.
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?
The two types of pneumonia vaccines are the pneumococcal conjugate vaccine or also known as Prevnar 13, and the pneumococcal polysaccharide or Pneumovax 23.
Prevnar 13 boosts a person’s immune system which allows the body to give protection against pneumonia. It is called Prevnar 13 because it can protect your body against 13 strains of the Streptococcus pneumoniae, which is the bacteria that causes pneumonia.
Just like with Prevnar 13, Pneumovax 23 is named because it protects you from 23 strains of Streptococcus pneumoniae. Out of the two vaccines, Pneumovax 23 is generally the more preferred vaccine in the medical establishment.
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 test strips for diabetes?