Prevnar 13 Medicare Coverage

Prevnar 13 is an injection used to vaccinate against Streptococcus pneumoniae, or the pneumococcal bacteria which can cause pneumonia and meningitis.

Medicare Part B covers pneumococcal vaccines such as Prevnar-13.

How much does Prevnar 13 cost with Medicare Advantage plans?

Medicare Part B covers pneumococcal shots at no cost to you.

Does Medicare Advantage cover Prevnar 13?

You don’t need a Medicare Advantage plan or a Medicare Part D prescription drug plan to get Prevnar 13 coverage.¹

If you have either type of private drug plan, you’re enrolled in Medicare Part B, and you qualify for Medicare coverage of Prevnar 13, your Part B benefits will cover Prevnar 13.

Some Medicare Advantage plans and Medicare Part D plans cover other prescription drugs that aren’t administered in a doctor’s office or by a medical professional.

• Part D plans or Medicare Advantage plans that cover drugs include copay amounts that can range widely from one plan to another. Plan members may also be responsible for meeting a deductible before the plan’s drug coverage kicks in.
  
  
• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). 89% of 2024 Medicare Advantage plans include prescription drug coverage.²
  
  
• Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You can find out if Medicare Advantage plan options in your area cover prescription drugs. We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Who should get the Prevnar 13 vaccine?

The Centers for Disease Control and Prevention (CDC) recommends Prevnar 13 for:

• Children under the age of two
• Adults over the age of 65
• People of any age with certain medical conditions

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

Written by Hayden Gharibyar, Pharm.D.