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Medicare and Pneumonia Vaccinations

There are certain persons who should consider getting vaccinated against pneumococcal infections, as following: babies, people aged over 65 years old, anyone at risk to develop the disease and people suffering from illnesses that make them liable to get infected.

In case you are over 65 years old, this means that you can take advantage of your Medicare insurance plan. But does this cover the costs of the shot or not?

pneumonia vaccinations

Medicare Coverage for the Pneumonia Vaccine

Pneumonia is a widespread condition that affects the health of the lungs. It is an infection that can be caused by fungi, bacteria or viruses. The severity of the symptoms depends on each person, but they include the following: shortness of breath, cough, fever, as well as low levels of oxygen.

It appears that, in some situations, this condition can trigger complications, which is why many people end up being hospitalized when suffering from pneumonia.

Concurrently, after a certain age, you develop a higher sensitivity to diseases such as pneumonia. This is why many health specialists advise elderly citizens to consider the shot. This way, you can keep the most aggressive forms of the disease at bay.

There are different vaccines for pneumonia – namely the PCV13 and the PPSV23. Each vaccine is designated for a given type of pneumococcal pneumonia, aiming at safeguarding you from the infection.

That being said, your Medicare insurance provides coverage for both types of vaccines for pneumonia, as long as you are over the age of 65 years old. First of all, it is recommended to get the PCV13. Twelve months afterward, specialists advise taking the other one – the PPSV23.

Both vaccines are free of charge granted that your chosen healthcare provider abides by the Medicare Physician Fee Schedule. In case your healthcare provider considers that you should take an additional shot against the condition, this will be made at an extra cost.

Still, this is hardly the case. Hence, if you are more predisposed to suffer from a lung condition, you might need to take an additional shot. Otherwise, you shouldn’t stress about this.


At the same time, you won’t have to facilitate your vaccination history at the time of your vaccination against pneumonia. What you have to do is inform the healthcare provider of your previous shots, to ensure that he/she is acquainted with your medical background.

During the pneumonia shot, the specialist may assess that you might have another health problem that requires immediate addressing or might recommend you to further investigate an existing problem. In this scenario, any additional care might lead to extra costs. Hence, during any preventive visits to a healthcare provider, the odds are that Medicare will bill you. So, keep this in mind!

If you’re considering getting vaccinated against pneumonia, it makes sense to determine if your Medicare insurance plan allows you to do that free of charge. After establishing that, you can take the shot, in order to prevent unwanted health problems.

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