Medicare covers the pneumonia shot at no cost to you

Yes. Medicare Part B covers two pneumonia vaccines — Pneumovax 23 and Prevnar 20 — with no copay, coinsurance, or deductible. You pay nothing out of pocket. The vaccine is covered as a preventive service, which means Medicare considers it part of keeping you healthy rather than treating illness.

Which vaccine you receive depends on your age and vaccination history. If you are 65 or older and have never had a pneumonia shot, your doctor will recommend one or both based on current guidelines. If you had Pneumovax 23 years ago, you may now be may be able to access for Prevnar 20 as well. The exact sequence matters for protection, so your doctor will tell you which one to get and when.

You do not need to do anything special to use this benefit. Show your Medicare card at your doctor's office or pharmacy, and the vaccine is covered. No prior approval is required.

Key Takeaways

  • Medicare Part B covers both Pneumovax 23 and Prevnar 20 with zero cost to you — no copay, deductible, or coinsurance.
  • You are covered for at least one pneumonia vaccine at age 65, and may be covered for a second vaccine depending on your previous shots and current age.
  • Your doctor decides which vaccine you need based on your age, health history, and what you have received before.
  • You can get the vaccine at your doctor's office, a pharmacy, or a clinic — anywhere that accepts Medicare.

Who is covered and when

If you have Medicare Part B, you are covered for pneumonia vaccines. The timing and which vaccines depend on your age and what you have already received.

If you are 65 or older and have never had a pneumonia shot, you are covered for Pneumovax 23. If you are 65 or older and previously received Pneumovax 23, you are now covered for Prevnar 20 as well — usually at least one year after your Pneumovax 23 shot, though your doctor may recommend waiting longer depending on your health.

If you are under 65 but have certain chronic conditions — such as heart disease, lung disease, diabetes, or a weakened immune system — you may be covered for pneumonia vaccines. Your doctor will determine whether you meet the criteria based on your medical history.

Where to get the pneumonia shot

You can receive the pneumonia vaccine at any location that accepts Medicare: your primary care doctor's office, a walk-in clinic, an urgent care center, or a pharmacy such as CVS, Walgreens, or Rite Aid. Many pharmacies now offer pneumonia vaccines without an appointment.

Call ahead to confirm the vaccine is in stock, especially if you are looking for a specific one. Prevnar 20 is newer and some locations may have limited supply. Your doctor can also administer the vaccine during a regular visit.

Bring your Medicare card. You do not need a referral or prior approval from Medicare.

What happens if you have a Medicare Advantage plan

If you have a Medicare Advantage plan (Part C) instead of Original Medicare, pneumonia vaccines are still covered at no cost. However, you must use a provider in your plan's network, or you may be charged out of pocket.

Check your plan's provider directory or call the plan directly to find in-network locations near you that offer pneumonia vaccines. Your plan documents will also list which vaccines are covered.

Pneumovax 23 versus Prevnar 20

These are two different vaccines that protect against different strains of pneumococcal bacteria. Pneumovax 23 has been available for decades and covers 23 strains. Prevnar 20 is newer and covers 20 strains, but with stronger protection against some of the most serious ones.

Current guidance recommends that most people 65 and older receive both vaccines for the strongest protection. If you are 65 or older and have never had either vaccine, your doctor will likely give you Prevnar 20 first. If you previously received Pneumovax 23, your doctor will recommend Prevnar 20 as a follow-up shot.

The two vaccines can be given at the same visit or at different times — your doctor will decide based on your health and what you have already received. You do not have to choose between them; Medicare covers both.

What to bring and what to expect

Bring your Medicare card and any insurance cards you carry. If you are seeing a new provider, bring a list of any vaccines you have had in the past, including when you received them. This helps your doctor determine which vaccine you need.

The shot itself takes seconds. You may feel a sore arm for a day or two afterward, or mild fatigue. Serious side effects are rare. You do not need to fast or prepare in any special way.

After you receive the vaccine, you will get a record card showing what you received and when. Keep this for your records and share it with your doctor at future visits.

If you are unsure whether you have had a pneumonia shot

If you do not remember whether you have received a pneumonia vaccine, your doctor can check your medical records or contact your previous providers. Do not assume you have had one just because you do not remember it.

If your records are unclear or you received a vaccine many years ago and do not know which one, tell your doctor. They can review your history and recommend whether you need a vaccine now. Getting a vaccine you have already had is not dangerous, but it is unnecessary.

Frequently Asked Questions

Do I need a referral from my doctor to get the pneumonia shot?

No. You can walk into a pharmacy or clinic and request the pneumonia vaccine without a referral. However, if you want your primary care doctor to administer it or to confirm which vaccine you need based on your health history, you can schedule an appointment with them.

What if I have a Medigap plan — does that change my coverage?

No. Medigap plans cover what Medicare covers. Since Medicare covers pneumonia vaccines at no cost, your Medigap plan does not add anything. You still pay nothing out of pocket.

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 the flu shot, shingles vaccine, or other vaccines. Your doctor or pharmacist will let you know if any spacing is needed between vaccines.

What if I am on Original Medicare but also have a Medicaid plan?

Medicare is your primary payer for the pneumonia vaccine. Medicaid does not need to be involved. Show your Medicare card and you are covered.

Is there a cost if I get the pneumonia shot at an urgent care or pharmacy instead of my doctor's office?

No. As long as the location accepts Medicare, the vaccine is covered at no cost to you. The provider bills Medicare directly, and you pay nothing.