Pneumonia is an infection that targets the lungs and can cause fever, difficulty breathing, and other symptoms. Pneumonia shots help prevent pneumonia.
Medicare Part B covers two separate pneumonia vaccines. Part B covers the first shot if you have never received Part B coverage for a pneumonia shot before. You are covered for a different, second vaccination one year after receiving the first shot.
You are not required to provide a vaccination history when receiving the pneumonia vaccine. You can verbally tell the health care professional administering the shot if/when you have received past shots.
If you qualify, Original Medicare covers pneumonia shots at 100% of the Medicare-approved amount when you receive the service from a participating provider. This means you pay nothing (no deductible or coinsurance). Medicare Advantage Plans are required to cover pneumonia shots without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.
During the course of your pneumonia shot, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.