Medicare covers pneumonia shots, but which shot and when depends on your age and health history

Medicare Part B covers two pneumonia vaccines: pneumococcal conjugate vaccine (PCV20) and pneumococcal polysaccharide vaccine (PPSV23). Most people turning 65 get at least one of these shots as part of their preventive care. The specific vaccine you need, and whether you need both, depends on whether you've had pneumonia shots before and your current age.

Medicare pays the full cost of these vaccines with no copay or deductible when you get them from an in-network provider. You don't need a referral. The shot is considered preventive care, which is one of the benefits included in Part B.

Key Takeaways

  • Medicare Part B covers pneumococcal vaccines (PCV20 and PPSV23) with no out-of-pocket cost when given by an in-network provider.
  • Most people age 65 and older need at least one pneumonia shot, but the exact schedule depends on whether you've had previous pneumococcal vaccines.
  • You can get your pneumonia shot at your doctor's office, a pharmacy, or a health clinic — anywhere that accepts Medicare.
  • If you have certain chronic conditions like diabetes, heart disease, or lung disease, you may be due for pneumonia shots even before age 65.

Who should get a pneumonia shot under Medicare

If you are 65 or older and have never had a pneumococcal vaccine, Medicare covers PCV20 as a single shot. If you received PPSV23 in the past but not PCV20, you may need PCV20 now, depending on how long ago you got PPSV23 and your age at that time.

People under 65 with certain chronic conditions also may have access to for Medicare-covered pneumonia shots. These include chronic lung disease (including asthma and COPD), chronic heart disease, diabetes, liver disease, or a weakened immune system. If you have any of these conditions, ask your doctor whether you need a pneumonia vaccine.

People who smoke, live in long-term care facilities, or have had their spleen removed should also discuss pneumonia vaccination with their doctor, as they may be at higher risk.

How the two pneumonia vaccines work together

PCV20 is a newer vaccine that protects against 20 strains of pneumococcal bacteria. PPSV23 protects against 23 strains. They work differently: PCV20 triggers a stronger immune response in older adults, while PPSV23 covers some strains that PCV20 does not.

The Centers for Disease Control and Prevention (CDC) updated its recommendations in 2024. For most people 65 and older who have never had a pneumococcal vaccine, PCV20 alone is now the standard first step. If you had PPSV23 years ago, you may still need PCV20, and your doctor can tell you the timing based on your vaccination history.

If you are unsure which vaccines you've had, bring any old vaccination records to your appointment, or ask your doctor's office to check your records. Medicare and most health systems keep vaccination history on file.

Where to get your pneumonia shot on Medicare

You can get a pneumonia vaccine at your primary care doctor's office, an urgent care clinic, a pharmacy (such as CVS, Walgreens, or Rite Aid), or a community health center. All of these accept Medicare Part B for preventive vaccines.

Call ahead to confirm the provider has the vaccine in stock and accepts your Medicare plan. If you have a Medicare Advantage plan (Part C), check your plan's provider network first, as some plans have preferred pharmacies or clinics. The vaccine itself is covered, but you want to make sure you're going to an in-network location to avoid unexpected costs.

You do not need an appointment at many pharmacies — you can often walk in. At a doctor's office, you may need to schedule ahead, especially during flu season when demand is high.

What happens if you've already had a pneumonia shot

If you received a pneumonia vaccine before age 65, you may still need another one now. The timing depends on which vaccine you had and how old you were when you received it.

For example, if you had PPSV23 at age 50 because of a chronic condition, you would typically need PCV20 at age 65 or later. If you had PPSV23 at age 65 or older, you might need PCV20 at least one year later. The rules changed in 2024, so older recommendations may not explore to you now.

The best way to know what you need is to tell your doctor or pharmacist when you last had a pneumonia shot. They can look up the current CDC guidelines and tell you whether another vaccine is due.

Medicare Advantage and pneumonia shots

If you have a Medicare Advantage plan (Part C), pneumonia vaccines are still covered as part of your preventive care benefits. However, you must use a provider in your plan's network, or you may face a copay or higher cost.

Check your plan's provider directory or call the plan's customer service line to find in-network locations near you. Some Medicare Advantage plans cover vaccines at specific pharmacies or clinics, so it's worth confirming before you go.

The vaccine itself has no copay under Medicare rules, but if you go out of network, the plan may charge you. Staying in network protects you from that cost.

Side effects and what to expect

Pneumonia vaccines are generally safe. Common side effects are mild and short-lived: soreness or redness at the injection site, low-grade fever, or mild fatigue. These usually go away within a day or two.

Serious side effects are rare. If you have a history of severe allergic reactions to any vaccine ingredient, tell your doctor or pharmacist before the shot. Most people with common allergies (such as egg allergy) can still safely receive pneumonia vaccines.

After your shot, you can return to normal activities right away. There is no need to rest or avoid anything special. If you have questions about whether the vaccine is right for you because of a medical condition or medication you take, ask your doctor before your appointment.

Frequently Asked Questions

Can I get a pneumonia shot and a flu shot at the same time?

Yes. You can receive a pneumonia vaccine and a flu shot during the same visit, usually in different arms. There is no waiting period between them. Medicare covers both.

What if I'm on Original Medicare and also have a Medigap plan?

Pneumonia vaccines are covered by Medicare Part B, so your Medigap plan does not need to cover them separately. You pay nothing out of pocket as long as you see an in-network provider. Your Medigap plan may cover other preventive services, but the vaccine itself is handled by Part B.

Do I need a pneumonia shot every year like a flu shot?

No. Pneumonia vaccines are not annual shots. Depending on which vaccine you receive and your age, you may need one shot, two shots spaced apart, or a booster years later. Your doctor will tell you the schedule based on your history and current age.

What if my doctor says I don't need a pneumonia shot?

If your doctor has reviewed your vaccination history and determined you don't need one, that is a valid medical decision. Vaccination recommendations can vary based on your individual health. If you want a second opinion, you can ask another doctor or call your local health department for guidance.

Will Medicare cover a pneumonia shot if I get it while traveling out of state?

Yes, as long as the provider accepts Medicare. You may pay upfront and then submit a claim to Medicare for reimbursement, or the provider may bill Medicare directly. Keep your receipt and any paperwork from the visit. Call Medicare at 1-800-MEDICARE if you have questions about reimbursement.