Does Medicare Cover Pneumonia Shots?
Pneumonia is a serious type of lung infection that is caused by Streptococcus pneumoniae and 80 other similar types of pneumococcus bacteria. To prevent or at least reduce the risks of pneumonia, pneumonia shots or vaccines are recommended by CDC or the U.S. Centres for Disease Control and Prevention for anyone who is older than 65. Not just they, children less than 5 years old as well as people, who have a compromised health condition, should also get the pneumonia shots or vaccines. These vaccines usually cover 23 types of pneumonia causing bacteria.
There are two types of the pneumonia shots or vaccines - Pneumococcal polysaccharide vaccination PPSV23 and Pneumococcal conjugate vaccination PCV13. Usually, the PPSV23 is recommended for most people above 65 years old or people with certain risk factors. If this pneumonia shot is not enough for the person, then only the doctor will recommend a second dose of PCV13.
Does Medicare cover Pneumonia Shots?
Medicare Part B covers one shot or vaccine for pneumonia under general conditions. If the licensed health care provider participates in the Medicare program, the person enrolled to the Medicare plan is entitled to get the pneumonia shot free of cost. The person has to pay no money for the pneumonia vaccine.
In case, the doctor prescribes a second dose of the other type of pneumonia vaccine, Medicare Part B will also cover that. However, this has to be after a year of the first dose of the pneumonia vaccine.
When the doctor prescribes a second dose of the PPSV23, there can be a question of whether Medicare Part B covers the shot or not. Certainly, the Medicare Advantage Plan or a Medicare supplement may cover the second shot of the same vaccine that has already been given previously. If you are not enrolled to the Medicare Supplement or Medicare Advantage Plan and still have to take the second shot of a previously taken pneumonia vaccine, then you will not be covered by Medicare. In that case, you will have to pay for the additional costs from your pocket.
However, of course, you can call your Medicare provider and discuss if there are plans that you can switch to or ways that will help you to save, in case the cost is a concern for you.
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