Does Medicare Cover Pneumonia Shots (Prevnar 13)?

Medicare beneficiaries seeking to maintain their health through safe and effective vaccines may wonder which vaccines are covered by their plan. Medicare Part B does cover two pneumonia vaccinations, including Prevnar 13, as routine preventative care. Coverage for pneumonia vaccines is also available through Medicare Part C (Medicare Advantage) plans. 

Prevnar 13 and Pneumovax 23 

There are two pneumonia vaccines available: Prevnar 13 and Pneumovax 23. Each shot protects against different strains of bacteria that can cause pneumonia and related complications like meningitis. 

The Prevnar 13 vaccine protects against 13 Streptococcus pneumoniae strains. Doctors may recommend the Prevnar 13 shot for: 

• Some older adults
• People with underlying immune conditions
• Those who live in long-term care facilities

Although Prevnar 13 isn't necessary for everyone, Medicare does cover the pneumonia shot. Beneficiaries should talk to their doctor about whether to get one or both vaccines. 

Does Medicare Pay for Both Pneumonia Vaccines?

Medicare Part B will pay for both Prevnar 13 and Pneumovax 23. Beneficiaries can get the first vaccine at any time, and the other shot will be covered if given at least one year later. Enrollees should follow their doctor's advice when deciding which vaccine to get first. 

How Much Does the Pneumonia Vaccine Cost? 

Medicare Part B covers the total cost of Prevnar 13, with no copays, as long as the beneficiary gets the vaccine through a provider who accepts Medicare. Enrollees in Medicare Part C plans can also get full coverage for the shots if administered through an in-network provider. Without coverage, the cost of a Prevnar 13 pneumonia shot is about $263. Because pneumonia shots are covered by Medicare Part B, beneficiaries can get vaccinated at no cost even if they don't have a Medicare Part D prescription drug plan. 

Which Vaccines Does Medicare Cover? 

Medicare Part B covers: 

• Pneumococcal (pneumonia) shots
• Hepatitis B shots
• Influenza (flu shots)
• The COVID-19 vaccine 

Other vaccines may be covered through Medicare Part D prescription drug plans.