Medicare covers pneumonia shots at no cost to you

Yes, Medicare Part B covers pneumonia vaccines without a copay or coinsurance if you receive them from an in-network provider. You pay nothing out of pocket for the shot itself. The vaccine is considered a preventive service, which means Medicare covers it in full once you meet the may be able to access requirements based on your age or health status.

The pneumonia vaccines Medicare covers are Pneumovax 23 (also called PPSV23) and Pneumococcal conjugate vaccines like Prevnar 20 or Prevnar 15. Which one you need depends on your age and whether you have certain chronic conditions. Your doctor will recommend which vaccine is right for you based on current CDC guidelines.

Key Takeaways

  • Medicare Part B covers pneumonia vaccines at no cost if you receive them from an in-network provider.
  • You are covered for Pneumovax 23 if you are 65 or older, or if you are younger with certain chronic conditions like diabetes, heart disease, or lung disease.
  • Pneumococcal conjugate vaccines (Prevnar 20 or Prevnar 15) are covered for adults 65 and older, and for younger adults with specific health conditions.
  • Your doctor can give you the shot at their office, or you can receive it at a pharmacy, hospital, or community health center — as long as the provider accepts Medicare.
  • If you use an out-of-network provider, you may owe the full cost, so always confirm the provider accepts Medicare before your appointment.

Who Medicare covers for pneumonia vaccines

If you are 65 or older, Medicare Part B covers pneumonia vaccines. You do not need to have any specific health condition — age alone qualifies you. Your doctor will determine which vaccines you need based on whether you have received pneumonia shots before and which vaccines are recommended for you at this time.

If you are younger than 65, Medicare covers pneumonia vaccines if you have one of these chronic conditions: chronic heart disease, chronic lung disease (including asthma and COPD), diabetes, liver disease, or a weakened immune system. You must also be enrolled in Medicare Part B. If you are unsure whether your condition qualifies, ask your doctor or call Medicare at 1-800-MEDICARE to confirm.

The difference between Pneumovax 23 and pneumococcal conjugate vaccines

Pneumovax 23 (PPSV23) has been the standard pneumonia vaccine for older adults for many years. It protects against 23 types of pneumococcal bacteria. If you are 65 or older and have never had a pneumonia shot, or if you had one more than 5 years ago, you may be due for this vaccine.

Newer pneumococcal conjugate vaccines — Prevnar 20 and Prevnar 15 — protect against more types of bacteria and may offer stronger protection. As of 2024, the CDC recommends that adults 65 and older receive at least one dose of a pneumococcal conjugate vaccine. Some people may need both types of vaccine, given in a specific order. Your doctor will tell you which vaccines you need and when to receive them.

Both types of vaccine are covered by Medicare Part B at no cost to you. The difference is in how they work and how many types of bacteria they protect against — not in what you pay.

Where you can get your pneumonia shot

You can receive a pneumonia vaccine at your doctor's office, a pharmacy (such as CVS, Walgreens, or Rite Aid), a hospital, or a community health center. The location does not matter as long as the provider accepts Medicare. Many pharmacies now offer pneumonia shots without an appointment, which can make it convenient to get vaccinated while running errands.

Before you go, call ahead or check the provider's website to confirm they accept Medicare. If you use an out-of-network provider — one that does not accept Medicare — you will likely owe the full cost of the vaccine. Medicare will not reimburse you after the fact. Staying in-network ensures you pay nothing.

What happens after you get the shot

After you receive a pneumonia vaccine, your provider should record it in your medical record and in the Medicare system. This record helps your doctor know which vaccines you have had and whether you need additional doses in the future. Some people need two different pneumonia vaccines given weeks or months apart, depending on their age and health history.

You may experience mild side effects such as soreness at the injection site, low-grade fever, or fatigue. These effects usually go away within a day or two. Serious side effects are rare. If you have concerns about side effects or feel unwell after the shot, contact your doctor.

If you have Part A only or do not have Part B

Pneumonia vaccines are covered under Medicare Part B, which is the part of Medicare that covers outpatient services and preventive care. If you have only Medicare Part A (hospital insurance) and have not enrolled in Part B, you will not have coverage for the pneumonia shot unless you enroll.

If you are not yet 65 and have Medicare because of disability or end-stage renal disease, you are still may be able to access for Part B coverage of pneumonia vaccines if you meet the age or health condition requirements described above. If you are unsure about your coverage, call 1-800-MEDICARE to speak with a representative who can review your specific situation.

Frequently Asked Questions

Do I need a pneumonia shot if I already had one years ago?

It depends on your age and which vaccine you received. If you had Pneumovax 23 more than 5 years ago, you may be due for another dose or for a newer pneumococcal conjugate vaccine. Current CDC guidelines recommend that adults 65 and older receive at least one pneumococcal conjugate vaccine. Your doctor can review your vaccination history and tell you what you need.

Will Medicare pay if I get the shot at a pharmacy instead of my doctor's office?

Yes, as long as the pharmacy accepts Medicare. Most major pharmacy chains (CVS, Walgreens, Rite Aid) accept Medicare for vaccinations. Always confirm before your visit. If you use an out-of-network pharmacy, you may owe the full cost.

What if I have a Medicare Advantage plan instead of Original Medicare?

Medicare Advantage plans (Part C) must cover all the same preventive services as Original Medicare, including pneumonia vaccines, at no cost. However, you must use providers in your plan's network. Check your plan documents or call your plan to find in-network locations near you.

Can I get a pneumonia shot if I am allergic to eggs or other ingredients?

Tell your doctor about any allergies before you receive the vaccine. Most pneumonia vaccines do not contain eggs, but your doctor needs to know your full allergy history to make sure the vaccine is safe for you. In rare cases, an alternative vaccine or special precautions may be needed.

Do I need to pay anything out of pocket for the pneumonia shot?

No. If you have Medicare Part B and use an in-network provider, the pneumonia vaccine is covered in full at no cost to you. You should not owe a copay, coinsurance, or deductible for this preventive service.