Medicare covers pneumonia shots at no cost to you

Yes. Medicare Part B covers two pneumonia vaccines — pneumococcal polysaccharide vaccine (PPSV23) and pneumococcal conjugate vaccine (PCV20 or PCV15) — with no copay, coinsurance, or deductible. You pay nothing out of pocket when you receive the shot at a participating provider.

The vaccine protects against pneumococcal disease, which can cause pneumonia, meningitis, and bloodstream infections. Medicare considers these shots preventive care, which means they fall under the coverage that Part B provides at no cost to beneficiaries.

Which vaccine you receive and when depends on your age and vaccination history. Your doctor will recommend the right shot for you based on current CDC guidelines, which change periodically as new vaccines become available.

Key Takeaways

  • Medicare Part B covers pneumonia vaccines with zero out-of-pocket cost when you go to a participating provider.
  • You may need one or two pneumonia shots depending on your age and whether you have received pneumonia vaccines before.
  • Your doctor or pharmacist can tell you which vaccine you need and when to receive it based on your medical history.
  • You can receive pneumonia shots at your doctor's office, a hospital outpatient clinic, or a pharmacy that accepts Medicare.

Which pneumonia vaccines Medicare covers

Medicare covers PCV20 (Pneumovax 20) and PCV15 (Prevnar 15) as newer conjugate vaccines, as well as PPSV23 (Pneumovax 23), the older polysaccharide vaccine. The CDC updated its pneumonia vaccination recommendations in 2024, and most adults now receive PCV20 as a single shot rather than the older two-shot sequence.

If you are 65 or older and have never had a pneumonia shot, your doctor will likely recommend PCV20 as a one-time dose. If you received PPSV23 in the past, you may need PCV20 or PCV15 at a later date, depending on how long ago you got the first shot and your health history.

Adults under 65 with certain chronic conditions — such as heart disease, diabetes, or lung disease — or weakened immune systems may also be covered for pneumonia vaccines. Your doctor will determine whether you meet the criteria based on your medical records.

Where to get your pneumonia shot

You can receive a pneumonia vaccine at any provider that accepts Medicare, including your primary care doctor's office, a hospital outpatient clinic, an urgent care center, or a pharmacy such as CVS, Walgreens, or Walmart. Call ahead to confirm the provider has the vaccine in stock and accepts your specific Medicare plan.

If you have Original Medicare (Part A and Part B), you pay nothing at any participating provider. If you have a Medicare Advantage plan, check your plan documents or call the plan to confirm the vaccine is covered and whether there are preferred locations where you should go.

You do not need a referral from your doctor to get a pneumonia shot at a pharmacy, though your pharmacist may ask about your medical history to make sure the vaccine is right for you. If you prefer to receive it from your doctor, you can schedule an appointment and ask specifically for the pneumonia vaccine.

What to bring when you get the shot

Bring your Medicare card and a photo ID. If you are going to a pharmacy, also bring any insurance cards you have, including supplemental or Medicare Advantage coverage. The provider will use your Medicare information to bill for the vaccine at no cost to you.

If you have received pneumonia vaccines before, bring records of those shots if you have them — or tell the pharmacist or doctor when and where you received them. This helps the provider decide whether you need another dose and which vaccine is appropriate. Many providers can look up your vaccination history in state registries or your doctor's records.

If you do not have records, do not worry. Your doctor or pharmacist can review your medical history and recommend the right vaccine based on your age and health conditions. You will not be charged extra for this assessment.

Timing and the two-vaccine sequence

If you are 65 or older and have never had a pneumonia shot, the current recommendation is usually a single dose of PCV20. This simplifies the process compared to older guidelines that required two separate shots given months apart.

If you received PPSV23 before age 65 or more than a year ago, you may be due for an additional dose of PCV20 or PCV15. The timing depends on your age, your original vaccine, and your health status. Your doctor will tell you when to come back if a second shot is needed.

There is no rush to get the vaccine if you have not had one yet, but it is worth scheduling sooner rather than later — pneumococcal disease can be serious, and the vaccine takes about two weeks to build protection. Medicare covers it whenever you decide to get it, as long as you are enrolled in Part B.

Medicare Advantage and supplemental coverage

If you have a Medicare Advantage plan (Part C), pneumonia vaccines are still covered at no cost because federal law requires all Medicare Advantage plans to cover the same preventive services as Original Medicare. However, you may have to use in-network providers to avoid extra charges.

If you have a Medigap supplemental policy, it does not affect your pneumonia vaccine coverage — Medicare Part B pays the full cost, and your supplemental plan does not add anything. You still pay nothing out of pocket.

Call your Medicare Advantage plan or supplemental insurer if you are unsure whether a specific provider is in-network, but the vaccine itself will always be free under your Medicare coverage.

Side effects and what to expect

Most people have no side effects or only mild ones. Common reactions include soreness, redness, or swelling at the injection site, or a low-grade fever or fatigue for a day or two. These are normal and usually go away on their own.

Serious allergic reactions are rare. Tell the provider before your shot if you have ever had an allergic reaction to any vaccine or to any ingredient in the pneumonia vaccine. Your doctor can discuss whether the vaccine is safe for you.

You can take over-the-counter pain relievers like acetaminophen or ibuprofen after the shot if you have soreness or fever, but check with your doctor first if you take blood thinners or have other health conditions. Most people feel fine and can go about their day normally after receiving the vaccine.

Frequently Asked Questions

Do I need a pneumonia shot if I already had pneumonia?

Yes. Having pneumonia in the past does not mean you are immune to pneumococcal disease, and the vaccine can still protect you from future infections. Talk to your doctor about whether you need the vaccine and when to receive it.

What if I am on Medicare but do not have Part B?

Pneumonia vaccines are covered under Part B. If you have Original Medicare Part A only, you will need to enroll in Part B to have the vaccine covered. If you have a Medicare Advantage plan, Part B coverage is included, so your vaccine is covered.

Can I get the pneumonia shot at the same time as other vaccines?

Yes. You can receive the pneumonia vaccine at the same visit as a flu shot, shingles vaccine, or other preventive vaccines. Getting multiple vaccines at once does not reduce their effectiveness and is safe for most people. Your doctor or pharmacist will confirm this is right for you.

Will Medicare pay if I get the pneumonia shot out of state?

Yes, as long as the provider accepts Medicare. Medicare coverage is the same nationwide. If you are traveling or live part of the year in another state, you can get the vaccine at any participating provider and Medicare will cover it with no cost to you.

What if my doctor says I do not need the pneumonia shot?

Follow your doctor's recommendation. Not everyone needs a pneumonia vaccine — it depends on your age, health history, and risk factors. If you disagree with your doctor's decision, you can ask for a second opinion or discuss your concerns at your next visit.