Pneumonia is one of the most common illnesses in the United States. Every year it sends over one million people to the hospital and is the cause of death for over 50,000.

Pneumonia, viral or bacterial, is a severe infection that promotes inflammation in one or both of the lungs’ alveoli. These air sacs fill up with fluid and make breathing difficult. In this county, the most common causes of viral pneumonia are influenza and respiratory syncytial virus (RVS), and the most common cause of bacterial pneumonia is the pneumococcus bacteria. People most vulnerable to pneumonia are children under five, adults over 65, smokers, and those with chronic medical conditions.

Fortunately, there are vaccines available for these common types of pneumonia, and those who are at a higher risk of contracting it are encouraged to get the vaccines.

If you are covered by Medicare insurance, you may be at an age that carries a high risk for pneumonia, that is why you should have information about how your Medicare coverage pays for pneumonia treatments.

Who is at high risk for pneumonia?

You may be at higher risk for pneumonia if you are 65 years old or older or have a chronic illness such as:

• Cystic fibrosis
• Asthma
• Diabetes
• Congestive heart failure
• Liver or kidney disease

Other risk factors include having a long history of tobacco or alcohol use, a weakened immune system, or a difficulty coughing due to stroke or other causes.

The two most common causes of pneumonia are viruses and bacteria. For adults, viruses are responsible for over 30 percent of the cases. Common pneumonia-causing viruses include rhinovirus (the common cold), influenza, and coronaviruses such a s COVID-19 which has been ravaging the world since the end of 2019.

Different types of bacteria are responsible for community-acquired pneumonia (CAP), and the streptococcus pneumoniae bacteria are found in around 50 percent of all cases, making it the most prevalent bacteria in CAP cases.

The most common symptoms of pneumonia are:

• Cough
• Fever
• Coughing up phlegm
• Racing pulse
• Fast, shallow breathing
• Chest pain when taking deep breaths
• Fatigue, feeling weak
• Headache
• Confusion, mainly in senior patients

Doctors treat bacterial pneumonia with antibiotics and viral pneumonia with certain antiviral medications, but mainly with rest and fluids.

In many cases people recover from pneumonia, but there is still a high death rate, especially among seniors. In the United States today, pneumonia is still one of the most expensive conditions treated in hospitals. These are reasons why preventive treatments are so important.

What preventive treatments are available and how does Medicare insurance pay for them?

For people who are 65 and older, the Centers for Disease Control and Prevention (CDC), suggests getting two vaccines to help prevent some forms of pneumonia. These two vaccines are the PCV13 and PPSV23.

The pneumococcal polysaccharide vaccine (PPSV23) and the pneumococcal conjugate vaccine (PCV13) are both covered by Medicare Part B (medical insurance). Your Medicare coverage is 100 percent for both of these vaccines. You do not pay anything if you get the vaccines from a health care provider that accepts Medicare assignment.

It is important to note that Medicare pays for the initial vaccine whenever your health care provider administers it, and the second, different vaccine when it is administered at least one year following the initial vaccine.

If your health care provider suggests that you receive both the PPSV23 and PCV13 vaccines, you should get the PCV13 first. This is recommended for adults 65 years or older who have never received a pneumococcal vaccine before and also have a condition that weakens the immune system, a cerebrospinal fluid leak, or have a cochlear implant. If you have already had a PPSV23 vaccine, you must wait one year for the PCV13 vaccine.

The PPSV23 vaccine is recommended for all adults who are over the age of 65 even if they do not have the conditions mentioned above.

If you would like more information about these pneumococcal vaccines and whether your Medicare Part B includes them, you should discuss the details with your physician.

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