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Does Medicare pay for the pneumonia shot?


Yes. Medicare Part B pays for the vaccine that helps protect you against pneumococcal disease, which can cause several types of infections, such as pneumonia and meningitis. Medicare covers the pneumococcal vaccine in full, with no cost sharing, as a free preventive service.

According to the Centers for Disease Control and Prevention (CDC), about 1 in 10 of all patients with invasive pneumococcal disease die of their illness, and the risks are especially high for older patients. But the vaccine can reduce your chance of getting pneumococcal disease or reduce its severity.

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The CDC recommends that all adults 65 and older get the pneumonia vaccine. The federal Food and Drug Administration (FDA) licenses four pneumococcal vaccines for use in the U.S. Some types are recommended for children and others for adults.

What type of pneumonia shot can I get?

In 2021, Medicare updated its coverage of the pneumonia vaccine to align with new CDC Advisory Committee on Immunization Practices (ACIP) recommendations. Two kinds of vaccines help prevent pneumococcal disease. One type is a pneumococcal conjugate vaccine that comes in three variations: PCV13, PCV15 and PCV20. The other type is a pneumococcal polysaccharide vaccine, PPSV23.

For those 65 and older who have never received a pneumococcal conjugate vaccine (PCV), it recommends either one dose of PCV20 or the two-dose regimen of PCV15, followed by PPSV23, typically at least one year later. People who are immunocompromised may receive the second dose sooner.

What if I don’t know if I’ve received a pneumonia vaccine?

Ask your doctor and other health care providers to check their vaccine records in order to find out whether you’ve received the pneumonia vaccine. Your state’s health department may also have a vaccine registry in which you can look up your immunization records. The CDC has guidance and links to help locate your vaccine records.

If you are still unable to find out whether you’ve received the vaccine in the past, ask your doctor about your options. The CDC’s recommendation for people 65 and older with an unknown pneumococcal vaccination history is generally the same as it is for people who have never received a PCV shot.

How much do I pay for the pneumonia shot?

The pneumonia vaccine is covered in full under Medicare Part B as a free preventive service. You don’t have to pay any deductibles, copayments or coinsurance if you go to a doctor or other provider who accepts assignment.

If you have a private Medicare Advantage plan rather than original Medicare, you may need to go to an in-network provider for the vaccine to be covered.

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Keep in mind

Several vaccines are covered as a free preventive service under Medicare Part B, including the hepatitis B vaccine and flu shot, in addition to the pneumonia vaccine.  

But some vaccines, such as the shingles shot, are covered under Medicare Part D rather than Part B. In the past, you may have been charged a copayment for the shingles vaccine, but the Inflation Reduction Act eliminated all out-of-pocket costs for vaccines that the CDC ACIP recommends for adults, starting in 2023.

A good time to discuss this with your doctor is during your  Welcome to Medicare visit in your first year with Medicare Part B or at your annual wellness visits you can receive each year after that. 

Updated February 28, 2023

        

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