Medicare Flu And Pneumonia Shots

Pneumococcal Diseases & Pneumonia Shots

There is a category of diseases called pneumococcal disease, of which pneumonia is one of the most dangerousthe other most dangerous being meningitis. People with diabetes are about three times more likely to die with flu and pneumococcal diseases, yet most dont get a simple, safe pneumonia shot.

Symptoms of pneumonia include:

Cough that can produce mucus that is gray, yellow, or streaked with blood Chest pain

Cdc Urges Vaccinations Against Pneumonia For People Age 65+

Each year were urged to get a flu shot to reduce our chances of catching influenza and spreading it to others. Many of us now are advised to consider vaccinating ourselves against pneumonia too.

Pneumonia is an infection of the lungs that can cause mild to severe illness in people of all ages. Depending on the cause, pneumonia can often be treated with medicine. According to the Centers for Disease Control and Prevention , vaccines can prevent some types of pneumonia.1

Forget the old saying about catching pneumonia because you went outside with wet hair. The CDC says pneumonia is caused by certain bacteria, viruses and fungi.2 Complications from other illnesseseven the cold or flucan lead to pneumonia.3 People over 65 are among the groups at greater risk of developing pneumonia, as are smokers, those with ongoing medical issues, and children under 5.4

Its important to note that not all strains of pneumonia are the same. Because pneumonia can develop from a variety of causes, pneumonia vaccines are only effective against some of them. Once you have pneumonia, antibiotics are the most common form of treatment.

The CDC has issued recommendations for adults 65 or older for 2 types of vaccines that guard against pneumonia. Specifically, the vaccines are designed to help prevent pneumococcal disease, an infection caused by certain bacteria that can lead to pneumonia. Both vaccines are safe and effective, but they cant be given at the same time.

Who Should Get A Pneumonia Shot

The Centers for Disease Control and Prevention recommends pneumonia vaccines for children younger than 2 years old and adults 65 years and older. Between the ages of 2 to 65 years, the pneumonia vaccine is only recommended for individuals that are at a higher risk due to certain medical conditions that lower their immune systems.

Pneumonia vaccines are best for high-risk groups such as people over the age of 65, smokers, and people with lung disease like COPD and asthma, says Amy Deviney, family nurse practitioner in Denver, CO. There are two vaccinations that should be given a year apart to protect from several different strains of pneumonia. Prevnar 13 given first and then Pneumovax 23 given a year later.

There are some individuals ages 65 years and older who should NOT get the vaccine according to the CDC:

• Any individual who has had a life-threatening or severe allergic reaction to Prevnar 13, Pneumovax 23, an earlier pneumonia vaccine labeled PCV7 , or a vaccine with diphtheria toxoid .
• Any individual who is not feeling well the day of the vaccine. You can reschedule your appointment for when you feel better.

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Where To Get Your Shots

You can get your flu and pneumonia shots at the following locations:

• Your doctors office. Call your primary care physician and make an appointment. Your office visit copay may apply for the visit, but the shots will come at no cost.
• A pharmacy. Call your local pharmacy before you go to make sure they offer flu and pneumonia shots. Youll also want to make sure that the pharmacy accepts your Medicare plan. Our pharmacy directory can help you find a location, too.
• A community health center. You can check with your local health department to see if there are community health centers that offer these shots and accept your Medicare plan.

Which Vaccines Do Older Adults Need

As you get older, a health care provider may recommend vaccinations, also known as shots or immunizations, to help prevent certain illnesses.

Talk with a doctor or pharmacist about which of the following vaccines you need. Make sure to protect yourself as much as possible by keeping your vaccinations up to date.

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What Is The Pneumonia Vaccine

There are currently two types of pneumococcal vaccines that cover different strains of a common type of bacteria that can lead to pneumonia. This type of bacteria poses risks for young children but can also be risky for those who are older or have compromised immune systems.

The two vaccines are:

• pneumococcal conjugate vaccine
• pneumococcal polysaccharide vaccine

According torecent data, the CDC Advisory Committee on Immunization Practices recommend that people who are 65 and older should get the Pneumovax 23 shot.

However, both vaccines may be needed in certain circumstances when there is greater risk. These situations can include:

• if you live in a nursing home or long-term care facility
• if you live in an area with many unvaccinated children
• if you travel to areas with a large population of unvaccinated children

Here is a comparison between the two available vaccines:

Pneumonia vaccines can prevent serious infections from the most common strains of pneumococcal bacteria.

Possible side effects

Does Medicare Cover Prevnar 13

Most vaccines required for preventive care are covered under Medicare Part D. Part D is optional prescription drug coverage that you may purchase from a private insurance company.

The two pneumonia vaccines, Prevnar 13 and Pneumovax 23, are covered instead by Medicare Part B. Flu shots are also covered by Part B.

Part B covers preventive care and medically necessary services you receive as an outpatient. Together Medicare Part A and Part B make up what is known as original Medicare.

To get full coverage for Prevnar 13, or any vaccine, youll have to go to a Medicare-approved provider. This may be a doctor, pharmacist, or other Medicare-approved professional. You can look up and compare Medicare-approved doctors and hospitals here.

Like Part D, Medicare Part C plans are purchased from private insurance providers. Part C plans must cover at least as much as original Medicare does. If you have a Part C plan, itll cover Prevnar 13 as long as you receive it from an in-network provider.

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Will Medicare Cover A New Coronavirus Vaccine Once Available

A vaccine for the 2019 novel coronavirus isnt currently available. But many pharmaceutical companies are developing vaccines in the hopes of protecting against the COVID-19, the disease caused by the virus.

A vaccine could put an end to a pandemic that has taken thousands of American lives. And whenever a coronavirus vaccine is available, Medicare and Medicare Advantage will cover the costs, according to the CARES Act.

The CARES Act states that a person with Medicare will not have to pay any cost-sharing for the vaccines. This means you wont have to pay a copayment or deductible toward getting a coronavirus vaccine.

What Vaccines Does Medicare Cover

Vaccines can become less effective over time. Even individuals fully vaccinated as children may need to update their immunizations. Medicare Parts B and D offer vaccination coverage.

Medicare Part B covers shots for the flu, hepatitis B, pneumococcal , and COVID-19. Medicare covers 100 percent of the cost of these vaccines if you go to an approved provider, and you do not have to pay a deductible or coinsurance. Medicare Advantage plans are also required to provide these vaccines at no additional costs.

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Medicare covers one flu shot per flu season, which runs from November to April, and not the calendar year. For example, if an individual gets a flu shot in January and again in November of the same year, Medicare would pay for both.

Medicare covers two different pneumonia shots. Medicare recipients can get the first shot at any time and it will cover the second shot if it’s administered at least one year after the first shot.

Hepatitis B shots are free for anyone considered medium or high risk for contracting the virus. End-stage renal disease and diabetes are two conditions that place individuals into a higher risk category. A medical professional can help determine an individuals risk level.

Keeping current on your vaccinations is one of the best ways to prevent serious illness and disease. Talk with your doctor to determine what vaccines you need to minimize risks to your health.

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Who Should Get Immunised Against Pneumococcal Disease

Anyone who wants to protect themselves against pneumococcal disease can talk to their doctor about getting immunised.

Pneumococcal immunisation is recommended for:

• infants and children aged under 5 years
• non-Indigenous adults aged 70 years and over without medical risk conditions for pneumococcal disease
• Aboriginal and Torres Strait Islander children aged under 5 years living in Northern Territory, Queensland, South Australia and Western Australia
• Aboriginal and Torres Strait Islander adults aged 50 years and over without medical risk conditions for pneumococcal disease
• infants under 12 months diagnosed with certain medical risk conditions for pneumococcal disease
• people over 12 months with certain medical risk conditions for pneumococcal disease

There are two types of pneumococcal vaccine provided free under the National Immunisation Program for different age groups and circumstances:

Refer to the NIP schedule for vaccine dosage information. Your doctor or vaccination provider will advise if you or your child have a specified medical risk condition.

Refer to the pneumococcal recommendations in the Australian Immunisation Handbook for more information.

What Is The Pneumococcal Vaccine And How Often Should You Get It

Both pneumococcal vaccines approved for use in the United States protect against multiple types of bacteria that can cause pneumonia. The schedule for taking them depends on your age and medical conditions.

Differences Between Pneumococcal Vaccinations

Pneumovax 23

Pneumovax 23 protects against 23 types of serious pneumococcal bacterial infections. Most adults will need only one shot of PPSV23 in their lifetime. But the CDC recommends up to two additional shots for adults with certain chronic medical conditions.

Prevnar 13

Prevnar 13 protects against the 13 most common types of pneumococcal bacteria that cause the most common serious infections in children and adults. Adults will receive this shot only if they have certain medical conditions and with the advice of their doctor. While children receive seven doses by the time they are 15 months old, adults who get this vaccine will only receive one shot of PCV13 in their lifetime.

Prevnar 20

Prevnar 20 is similar to Prevnar 13, but provides protection against 20 different types of pneumococcal bacteria. It is a more recent addition and Medicare began covering it in October 2021.

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Flu And Pneumonia Shots

Having the flu can be dangerous for anyone. But it is extra risky for people with diabetes or other chronic health problems. Having diabetes means having more instances of high blood glucose than a person without diabetes. High blood glucose hinders your white blood cells ability to fight infections.

Beyond people living with diabetes, flu is also extra risky for people with heart disease, smokers and those with chronic lung disease, people who have an impaired immune system , very young children, and people living in very close quarters, such as college dorms, military barracks, or nursing homes.

How Much Does The Pneumonia Vaccine Cost

Medicare Part B covers the total cost of Prevnar 13, with no copays, as long as the beneficiary gets the vaccine through a provider who accepts Medicare. Enrollees in Medicare Part C plans can also get full coverage for the shots if administered through an in-network provider. Without coverage, the cost of a Prevnar 13 pneumonia shot is about $263. Because pneumonia shots are covered by Medicare Part B, beneficiaries can get vaccinated at no cost even if they don’t have a Medicare Part D prescription drug plan.

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How Much Do Vaccines Cost

The cost for vaccines depends on which portion of Medicare is paying and what the vaccine is.

You wont pay anything for vaccines that Medicare Part B covers. But if you have Medicare Part C , you should check with your insurance plan.

You may need to get your vaccine from a plan-approved provider or pharmacy. If youre following the rules of your Medicare Advantage plan, you shouldnt have to pay anything for your vaccine.

If you get a vaccine that Part D covers, your Part D insurance company will negotiate a price that includes the vaccine costs and its administration. The costs include:

• dispensing fee
• vaccine administration fee
• vaccine ingredient costs

Your doctor will bill your Part D plan directly. You may be responsible for costs that include a copayment or coinsurance.

Sometimes, your plan may require you to pay your provider up front for the Medicare Part D vaccine, then submit a claim to your Part D plan for reimbursement. When this is the case, you may want to contact your plan before getting the vaccine just to confirm your coverage.

Problems That Could Happen After Getting Any Injected Vaccine

• People sometimes faint after medical procedures, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting and injuries caused by a fall. Tell your doctor if you or your child:
• Feel dizzy
• Have vision changes
• Have ringing in the ears

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Does Medicare Cover Pneumonia Shots

Medicare Part B covers pneumonia shots, according to medicare.gov. People enrolled in Medicare Part B can receive the first pneumonia shot at any time and a different, second shot if its given at least one year after the first.

Part B is included in both Original Medicare and Medicare Advantage plans , so both types of Medicare coverage will include pneumonia shots.

In order to get a covered pneumonia shot, people with Original Medicare must see a participating provider. Those with Medicare Advantage should have no cost-sharing at all as long as they see a provider in their plans network and they meet the other Medicare requirements for the shot.

The two pneumonia shots covered by Medicare Part B include the pneumococcal conjugate vaccine and the pneumococcal polysaccharide vaccine , which are the only approved vaccines in the United States for pneumonia.

The pneumonia vaccine is not the only vaccination Medicare covers. Medicare Part B and Medicare Part D both cover vaccinations depending on the medical indication of the vaccination.

For example, Medicare Part B covers pneumococcal shots, an annual flu vaccine, and the Hepatitis B vaccine whereas Medicare Part D plans cover the shingles vaccine, the meningitis vaccine, and the Tdap vaccine, which prevents tetanus, diphtheria, and pertussis/whooping cough.

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Finding Vaccines For Children

PCV13 is part of the routine childhood immunization schedule. Therefore, it is regularly available for children at:

• Pediatric and family practice offices
• Community health clinics

• Health departments
• Other community locations, such as schools and religious centers

You can also contact your state health department to learn more about where to get pneumococcal vaccines in your community.

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Shingles Vaccine For Older Adults

Shingles is caused by the same virus as chickenpox. If you had chickenpox, the virus is still in your body. As you get older, the virus could become active again and cause shingles.

Shingles affects the nerves. Common symptoms include burning, shooting pain, tingling, and/or itching, as well as a rash with fluid-filled blisters. Even when the rash disappears, the pain can remain. This is called post-herpetic neuralgia, or PHN.

The shingles vaccine is safe, and it may keep you from getting shingles and PHN. Healthy adults age 50 and older should get vaccinated with the shingles vaccine, Shingrix, which is given in two doses.

You should get a shingles vaccine even if youve already had chickenpox or the chickenpox vaccine, or if you don’t remember whether you had chickenpox. You should also get the shingles vaccine if you’ve already had shingles or received Zostavax. However, you should not get a vaccine if you currently have shingles, are sick or have a fever, have a weakened immune system, or have had an allergic reaction to Shingrix. Check with a health care provider if you are not sure what to do.

You can get the shingles vaccine at a doctors office and at some pharmacies. Medicare Part D and private health insurance plans may pay some or all of the cost. Check with Medicare or your health plan to find out if it is covered.

When To Get Your Shots

The best time to get your flu and pneumonia shots is any time after July 1 each year. This is because flu season typically begins in the fall. Peak months for the flu season in Michigan are November, December, January, February, March and April.

The flu spreads quickly during those peak months. So, getting vaccinated early is important, because it gives your body a chance to protect itself.

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