Does Medicare Cover Pneumonia Shots & Treatments?

Pneumonia is an infection of the lungs that often goes hand in hand with other illnesses, commonly the flu. Common symptoms include fatigue, coughing, shortness of breath, and nausea, among other signs. It can be caused by viruses, bacteria, and fungi, and it can be life-threatening when severe enough, particularly for seniors and children. Each year, nearly 250,000 people die from pneumonia. With the already weakened immune systems of many seniors, prevention and treatment is critical. That begs the question, can Medicare help you with pneumonia prevention and treatment? Also, does Medicare cover pneumonia shots?

With something as serious as pneumonia, health insurance coverage can go a long way toward helping you stay safe and get the treatment you need. In the case of pneumonia, the threat presented by this contagious infection is respected and reflected in your Medicare coverage in a few ways.

Medicare and Pneumonia Treatment

Rest assured, if you catch pneumonia, from someone who already has it or as part of another illness, Medicare should help cover your pneumonia treatments. Generally, doctors treat pneumonia with antibiotics (bacterial infections) or antivirals (viral infections). Your Medicare Part D plan or Medicare Advantage Prescription Drug plan should help to pay for either type of medication. Along with this prescription, your doctor may instruct you to take over-the-counter pain medications. Check if your plan has an over-the-counter medicine benefit. It’s possible it your Medicare coverage could help you pay for those types of medicines as well.

If your case is severe enough or you’re over the age of 65, your doctor may have you go to the hospital for treatment. Depending on your symptoms, you may receive fluids intravenously or even get breathing assistance from a ventilator. If you’re receiving treatment in a hospital, you’ll receive coverage through Medicare Part A. You’ll still have to pay a daily coinsurance and your Part A deductible while you’re an inpatient, but a Medicare Supplement or hospital indemnity plan could help you afford out-of-pocket expenses like these. You also should check if you’re in observation status, as that could end up costing you more than you expected.

Medicare Coverage of the Pneumococcal Shot

The most important way to protect yourself from pneumonia is to prevent it. While you can never 100 percent guarantee you won’t catch something, there are steps you can take to put the odds in your favor. The most significant of these, when it comes to preventing pneumonia, is getting a pneumococcal shot, also called a pneumonia vaccine. There are two types of pneumococcal vaccines, PCV13 for children younger than two years old and PPSV23 for adults age 65 and older. Both vaccines help guard against infections that pneumococcal disease causes. While these vaccines cannot fully prevent the illnesses, Centers for Disease Control and Prevention (CDC) studies show they can be highly effective in lowering one’s chances of getting sick with different types of pneumonia.

That’s all great news, but are pneumococcal shots covered by Medicare? Not only does your Medicare plan help cover this type of shot, but if you receive the shot from a qualified health care provider, one who accepts assignment, Medicare may fully cover it. That means you may not have to owe anything for getting the shot! Technically, Medicare covers two pneumococcal shots: the first one you ever receive and the second one you receive if it has been over a year after you’ve gotten the first vaccination. Keep in mind, if your doctor wants you to get services more than what Medicare covers, you may have to pay some or all the costs.

Should I Get the Pneumonia Vaccination?

Just like if you’re considering getting a flu shot, whether or not you get a pneumonia shot is definitely a discussion that you want to have with your doctor. Vaccinations generally aren’t dangerous, but there are cases where a vaccination may not be right for you. Examples of such cases could include if you’ve previously had an allergic reaction to an earlier dosage of either pneumococcal vaccination or a reaction to a previous vaccination containing the ingredients of a potential future vaccine. Your doctors know you and your health best, so have a quick conversation with them!

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Pneumonia is a common, highly contagious infection that is especially dangerous for seniors. That’s why it’s so important that Medicare offers pretty thorough coverage of what seniors need to not only protect themselves from catching pneumonia, but also get treatment if they do catch it.