Every year in the United States over five million people are affected by pneumonia, and community-acquired pneumonia is the sixth leading cause of death in the country.
Pneumonia sends over one million adults to the hospital yearly, making it the most common cause (after childbirth) for hospital admission.

Pneumonia affects people at any age, but adults over the age of 65 are even more vulnerable. Fortunately, it is preventable, and you can lower your risk by getting vaccinated and taking preventive measures.

Having all the facts about pneumonia, preventive vaccinations, and whether your Medicare insurance plan covers the cost of these vaccinations, is essential to your good health.

Does your Medicare insurance plan cover the cost of pneumonia shots?

People who have Medicare coverage under Part B of Original Medicare plan, or through a Medicare Advantage plan, have total coverage for pneumonia shots. You don’t have to pay anything if your doctor or health care provider accepts Medicare assignment.

Medicare insurance pays for two different pneumococcal shots. It covers the first shot whenever you get it, and a different, second shot, when it is administered at least one year following the initial shot.

The two shots that doctors recommend for people over 65 years of age are the pneumococcal conjugate and the pneumococcal polysaccharide vaccines. Your health care provider will sit down with you and discuss the type of vaccines you need and your vaccination schedule.

What is pneumonia?

Pneumonia is an infection of the lungs caused by virus, bacteria, or fungi. The infection causes inflammation of the air sacs in one or both lungs. In most instances, the air sacs fill up with fluid and this causes difficulty breathing, along with other symptoms.

The main types of pneumonia are:

• Community-acquired, the most common type, develops outside
a hospital or health care facility setting

• Hospital-acquired or healthcare associated cases develop in hospitals
or other facilities such as dialysis centers or long-term care

• Ventilator associated pneumonia can develop when a patient is on
a ventilator

Bacteria and viruses that can cause pneumonia differ in community and hospital settings. The most common causes of community-acquired viral pneumonia in the United States are influenza and respiratory syncytial viruses. The most common cause of bacterial pneumonia is streptococcus pneumoniae bacteria.

Who does pneumonia affect?

People who are at the highest risk for pneumonia are children under the age of two, and adults over the age of 65. Some of the other risk factors include the following:

• People with chronic obstructive pulmonary disease (COPD), asthma, or
heart disease
• Smokers
• People who have a compromised or weak immune system due to organ
transplant, chemotherapy, long-term steroid use, HIV/AIDS, etc.
• People who are in the hospital ICU, especially those on a ventilator

What are the symptoms of pneumonia?

Depending on the type of germ, the patient’s age, and health status, symptoms of pneumonia can range from mild to severe. If the symptoms are mild, they are like a cold or the flu, but they linger for a longer period.

Other common symptoms include:

• Fever with or without sweating and chills
• Phlegmy cough
• Chest pain while breathing or coughing
• Shortness of breath
• Fatigue
• In adults over the age of 65, their body temperature may go below normal
• In some cases, nausea, vomiting, or diarrhea are symptoms

How can pneumonia be avoided?

Because pneumonia is a common complication of the flu or other upper respiratory viruses, getting an annual flu shot is a strong defense against it. You also have Medicare coverage for flu shots with Medicare Parts B.

Other ways to prevent pneumonia besides getting vaccinated against it include general health advice:

• Wash your hands frequently and immediately after contact with
others, clean all surfaces that you touch regularly like your phone
• Don’t smoke and avoid second-hand smoke
• Keep your immune system strong with a healthy diet, proper sleep and

Most people recover fully from pneumonia, but it can be quite serious for those who are especially vulnerable. Take advantage of your Medicare Part B preventive coverage to lower your risk of pneumonia.

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Medicare.org Frequently Asked Questions (FAQ)

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