Does Medicare Cover Prevnar 13?

Medicare Part B does cover pneumococcal vaccines like Prevnar 13 that can be effective at preventing pneumonia. Under Medicare Part B, the Prevnar 13 vaccine is covered entirely.

If your doctor prescribes other outpatient care or if you require treatment for pneumonia, you will typically face out-of-pocket Medicare costs for covered care.

A Medicare Supplement Insurance (Medigap) plan can help pay for out-of-pocket costs like Medicare deductibles, copays, coinsurance and more.

Medicare Part B covers the Prevnar 13 pneumococcal vaccine.

How Much Does the Prevnar 13 Vaccine Cost With Medicare?

Medicare Part B covers pneumococcal vaccines like Prevnar 13 once.

Medicare Part B can also cover a different additional shot one year later. It's important to check your provider accepts Medicare assignment in order to receive the vaccine with full Medicare coverage.

How Effective Is Prevnar 13?

Prevnar 13 is a pneumococcal vaccine. It’s intended to prevent an infection of pneumonia and other pneumococcal infections.

According to the CDC, adults who receive a pneumococcal vaccine need only one dose in order to receive protection against the 13 types of bacteria that most regularly cause pneumonia.

Getting this vaccine shows a high level of effectiveness, the CDC notes. One dose of Prevnar 13, studies show, can help prevent:

• 75 out of 100 adults age 65 and older from getting invasive pneumococcal disease

• 45 out of 100 adults age 65 and older from getting pneumococcal pneumonia¹

About 69% of American seniors have received a pneumococcal vaccine, according to national estimates.²

Pneumococcal Infections Affect Thousands of Adults

The pneumonia infection, which is caused in part by the Streptococcus pneumonia bacteria, inflames the lungs and causes them to fill with fluid.

This causes coughing, fever, chills and trouble breathing. Additionally, with a pneumonia infection, oxygen can have trouble reaching your blood. This prevents your cells from working properly and can even cause death.

Most healthy people recover from pneumonia in one to three weeks. However, the infection can be much more dangerous for people over age 65.

That’s why the Centers for Disease Control and Prevention recommends pneumococcal vaccinations for adults 65 and older.

Find Medicare Supplement Plans That Help Cover Your Out-of-Pocket Costs

If you receive treatment for pneumonia or other health care services that are covered by Medicare, you may likely face out-of-pocket Medicare costs such as deductibles, coinsurance and copayments.

A Medicare Supplement Insurance (Medigap) plan can help cover some of these costs.

Learn more about common procedures that medicare covers.

A licensed agent can help you decide on a Medicare option that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live.

¹ Centers for Disease Control and Prevention (CDC). Pneumococcal Vaccination: What Everyone Should Know. (Reviewed Dec. 6, 2017). Retrieved from www.cdc.gov/vaccines/vpd/pneumo/public/index.html.

² CDC. Figure 5.1. Percentage of adults aged 65 and over who had ever received a pneumococcal vaccination: United States, 2006–2018. (May 29, 2019). Retrieved from https://www.cdc.gov/nchs/fastats/pneumonia.htm.

Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.