Prevnar 13 Medicare Coverage

Reviewed by Hayden Gharibyar, Pharm.D.

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

Medicare Part B may cover Prevnar 13 and certain other types of vaccines and preventive medicine.

If Medicare Part B covers your Prevnar 13 shot, a Medicare Advantage plan (Medicare Part C) would also cover Prevnar 13.

Does Medicare pay for the pneumonia vaccine?

Medicare Part B will typically cover your first pneumococcal shot at any time. It will typically cover your second shot as long as it's given at least one year after your first shot.

Medicare Advantage plans (Medicare Part C) are required by law to offer at least the same benefits as Original Medicare (Part A and Part B).

This means that if Medicare Part B covers your Prevnar 13 shot, so would a Medicare Advantage plan.

How much does Prevnar 13 cost with Medicare?

If you visit a doctor who accepts Medicare assignment, you won't pay anything for your covered Prevnar 13 shot.

Who should get the Prevnar 13 vaccine?

Prevnar 13, or the pneumococcal conjugate vaccine, protects against 13 types of pneumococcal bacteria.

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

Most Medicare Advantage plans and Part D plans cover prescription drugs

Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.¹

Medicare Part D prescription drug plans also cover retail prescription drugs.

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

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.

Some Medicare Advantage plans also include benefits such as routine dental, hearing and vision coverage.

A licensed insurance agent can help you learn more about Medicare Advantage plans that are available where you live, including the benefits they offer. $0 premium plans may be available in your area.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.