Medicare covers pneumonia vaccines at no cost to you

Yes, Medicare Part B covers two pneumonia vaccines — Pneumovax 23 (also called PPSV23) and Prevnar 20 (also called PCV20) — with no copay, coinsurance, or deductible. You receive them at no charge when you get them from a Medicare-enrolled provider. The vaccines protect against different strains of pneumococcal disease, which causes pneumonia, meningitis, and bloodstream infections.

Which vaccine you receive depends on your age and health history. Medicare's coverage rules changed in 2024 to reflect new guidance from the Centers for Disease Control and Prevention (CDC). Understanding which vaccine applies to you and when to get it prevents confusion at your doctor's office and ensures you have the protection you need.

Key Takeaways

  • Medicare Part B covers both Pneumovax 23 and Prevnar 20 with no out-of-pocket cost when given by a Medicare-enrolled provider.
  • If you are 65 or older and have never had a pneumonia vaccine, you typically receive Prevnar 20 first, followed by Pneumovax 23 at least one year later.
  • If you received Pneumovax 23 before age 65, you may be due for Prevnar 20 at age 65 or older, depending on when you last received it.
  • Your doctor or pharmacist can review your vaccination history and tell you which vaccine you need and when to schedule it.
  • You can receive pneumonia vaccines at your doctor's office, a hospital, or a pharmacy that accepts Medicare.

Who should get pneumonia vaccines under Medicare

All Medicare beneficiaries age 65 and older are covered for pneumonia vaccines. If you are under 65 but have Medicare due to disability or end-stage renal disease, you are also covered. Additionally, Medicare covers pneumonia vaccines for people of any age with certain chronic conditions — including chronic lung disease, heart disease, diabetes, or a weakened immune system — even if they are not yet 65.

Your doctor can tell you whether you fall into a group that should receive these vaccines. If you have questions about your specific health situation, bring your Medicare card to your next appointment and ask your provider which vaccines are right for you.

The difference between Prevnar 20 and Pneumovax 23

Prevnar 20 is a newer vaccine that protects against 20 strains of pneumococcal bacteria. Pneumovax 23 protects against 23 strains. Both are covered by Medicare at no cost. The CDC recommends Prevnar 20 as the first vaccine for most people age 65 and older who have never had a pneumonia vaccine, because it covers more strains and provides stronger protection for older adults.

If you already received Pneumovax 23 before turning 65, you may still need Prevnar 20 later. The timing depends on how long ago you received Pneumovax 23. Your doctor will review your records and let you know if you need the second vaccine and when to schedule it. In most cases, you wait at least one year between the two vaccines.

When to schedule your pneumonia vaccines

If you are turning 65 or have just become may be able to access for Medicare, ask your doctor about pneumonia vaccines at your next visit. You do not need to wait for a specific time of year — you can receive these vaccines any time. Many people get them during their annual wellness visit or at the same time as their flu shot, though they can be given separately.

If you received Pneumovax 23 years ago and are now 65 or older, your doctor may recommend Prevnar 20. The timing depends on when you last received Pneumovax 23, so bring any vaccination records you have to your appointment. If you do not have records, your doctor can check your medical history or contact your previous providers.

Where to get your pneumonia vaccines

You can receive pneumonia vaccines at your primary care doctor's office, a hospital, or a pharmacy that accepts Medicare — including major chains like CVS, Walgreens, and Rite Aid. Call ahead to confirm they have the vaccine in stock and that they accept your Medicare coverage. When you arrive, bring your Medicare card.

If you use a Medicare Advantage plan instead of Original Medicare, your coverage may vary slightly. Check your plan documents or call the plan's customer service line to confirm which vaccines are covered and where you can receive them. Most Medicare Advantage plans cover both pneumonia vaccines at no cost, but the list of in-network providers may be different from Original Medicare.

What happens after you receive the vaccine

Pneumonia vaccines are safe and side effects are usually mild. Some people experience soreness at the injection site, low-grade fever, or mild muscle aches for a day or two. These effects go away on their own. Serious side effects are rare.

After you receive your first pneumonia vaccine, your provider will note it in your medical record. If you need a second vaccine (such as Pneumovax 23 after Prevnar 20), your doctor will schedule it for the appropriate time. Keep track of which vaccines you have received so you can tell future providers about your vaccination history.

Frequently Asked Questions

Can I get both pneumonia vaccines at the same time?

No. If you need both Prevnar 20 and Pneumovax 23, you must wait at least one year between them. Your doctor will schedule the second vaccine after the appropriate waiting period has passed.

What if I already paid for a pneumonia vaccine before I knew Medicare covered it?

Contact the provider or pharmacy where you received the vaccine and ask about a refund or credit. You may also contact Medicare at 1-800-MEDICARE to ask about reimbursement options. Keep your receipt and any paperwork from the visit.

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

No. Pneumonia vaccines are not annual shots. Once you have received the vaccines recommended for you, you typically do not need them again. Your doctor will tell you if circumstances change and you need additional protection.

What if my doctor recommends a pneumonia vaccine that is not Prevnar 20 or Pneumovax 23?

Other pneumonia vaccines exist but are not covered by Medicare. If your doctor recommends a different vaccine, ask whether Medicare covers it. If it does not, ask your doctor whether one of the covered vaccines would work for your situation.

Can I get a pneumonia vaccine at a pharmacy if I use Medicare Advantage?

Yes, but check your plan first. Some Medicare Advantage plans have preferred pharmacies or require you to use in-network providers. Call your plan's customer service number to confirm which pharmacies are covered and whether you need prior approval.