Medicare coverage of pneumonia shots

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Medicare will cover 100 percent of the cost of your pneumonia vaccine with no Part B deductible required if you are in Original Medicare or a Medicare Advantage plan (private health plan). Private plans cannot require that you get a referral for the vaccine, but can require that you use network providers. You should call your plan to find out what rules apply. If you are in Original Medicare you will pay no copay or deductible if you see providers who take assignment. Doctors and other health care providers who take assignment cannot charge you more than the Medicare approved amount.

In most cases, you will only need a pneumonia vaccine once in your lifetime. However, in rare cases, Medicare may pay for more than one shot in a lifetime. If someone is high risk, Medicare covers the pneumonia vaccine once every five years. People are considered at high risk for pneumonia if they have any of the following:

  • No spleen or a spleen that does not function properly (e.g., from sickle cell disease)
  • Human Immunodeficiency Virus (HIV)
  • Leukemia
  • Lymphoma
  • Hodgkin’s disease
  • Multiple myeloma
  • Generalized malignancy
  • Chronic renal failure
  • Nephrotic syndrome
  • Other conditions associated with immunosuppression

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LINKS
Medicare.gov -- Search for Participating Physicians

Lung Cancer Online

The American Lung Association

National Emphysema Foundation

National Directory of Medicare Regional Carriers and Intermediaries

Medicare.gov: National A/B MAC Information

 
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