Key Takeaways

  • Pneumonia refers to an infection in which the air sacs in the lungs fill with fluid. It can affect one or both of the lungs.

  • While pneumonia can affect anyone at any age, adults over the age of 65 are particularly vulnerable.

  • Vaccination can help older adults prevent pneumonia. Medicare Part B covers 100% of the cost of the pneumococcal vaccine.

According to Medicare.gov, approximately 1 million Americans go to the hospital with pneumonia every year. In fact, pneumonia is a leading cause of hospitalization in adults. It also has the potential to be deadly, claiming the lives of 18,000 adults age 65 and older annually. 

What is pneumonia?

Pneumonia refers to an infection in which the air sacs in the lungs fill with fluid. When this happens, the oxygen you breathe in is not as readily absorbed by your blood. Pneumonia can affect one or both of the lungs.

Symptoms of pneumonia include fatigue, sudden onset of fever and chills, chest pain, shortness of breath, and coughing that produces green or yellow fluid (sputum). The severity of this illness can range from mild to life-threatening.

What causes pneumonia?

Pneumonia can be caused by bacteria, viruses, and fungi. However, its most common cause is the bacterial strain Streptococcus pneumoniae (pneumococcus). Infections caused by this bacteria are generally referred to as pneumococcal disease. They can attack different parts of the body such as the bloodstream and/or vital organs.

There are three primary types of pneumonia:

  • Community-acquired pneumonia - When a patient develops pneumonia outside of the healthcare setting.
  • Healthcare-associated pneumonia - When a patient develops pneumonia during or after a stay in a hospital or long-term care facility.
  • Ventilator-associated pneumonia - When a patient develops pneumonia after being on a ventilator (breathing machine).

Who is at risk for developing pneumonia?

While pneumonia can affect anyone at any age, adults over 65 are particularly vulnerable. This is because as we age, our immune system weakens and cannot fight off pathogens as effectively. Older adults are also more likely to have chronic health conditions (comorbidities) and other risk factors. These can increase the likelihood of developing pneumonia, and include:

  • Asthma
  • Chronic obstructive pulmonary disorder (COPD)
  • Congestive heart failure
  • Cystic fibrosis
  • Smoking tobacco
  • Liver or kidney disease
  • Diabetes
  • Compromised immune system due to chemotherapy, HIV/AIDS or other factors
  • Recent respiratory infection

How is pneumonia treated?

Treatment for pneumonia depends on the cause of the infection and its severity. Mild cases can usually be treated at home. Hospitalization may be required for cases that have progressed.

  • If you develop pneumonia from bacteria, you may be given antibiotics orally or intravenously (IV).
  • If your pneumonia is caused by a virus, antiviral medications may be given, but treatment is typically limited to supportive care. This includes rest, plenty of fluids, and over-the-counter (OTC) medications to help ease symptoms. In some cases, supplemental oxygen therapy may be administered.

How can older adults prevent pneumonia?

Regular hand washing and a healthy lifestyle (including not smoking) can help seniors keep pneumonia and other illnesses at bay. But the most important thing you can do to prevent pneumonia is get the pneumococcal vaccine. You should also get the influenza vaccine (the high-dose version formulated for older adults) every year, since pneumonia is a common complication of the flu.

The Centers for Disease Control and Prevention (CDC) recently updated its guidance, advising that adults age 65 and older get vaccinated to help prevent some forms of pneumonia. The same guidance applies to adults ages 19 to 64 with certain underlying medical conditions (e.g., chronic heart or lung disease, HIV, diabetes) or certain risk factors (e.g., smoking). For both groups of patients, a pneumococcal conjugate vaccine is recommended. This can be either:

  • a dose of PCV20 (Prevnar 20), or
  • a dose of PCV15 (Vaxneuvance). If PCV15 is used, this should be followed by a dose of PPSV23 (Pneumovax 23).

This CDC update applies to patients who have not previously received a pneumococcal conjugate vaccine or whose vaccination history is unknown. Ask your doctor which pneumococcal vaccine is right for you.

Does Medicare pay for flu and pneumonia shots?

Yes—Medicare does cover 100% of the pneumococcal vaccine under Medicare Part B. Medicare Part B also covers one flu shot every flu season and additional flu shots if deemed medically necessary.

This means that you should have no out-of-pocket costs if you get your vaccines from a healthcare provider that accepts Medicare. If you have Medicare Advantage, you may have to use an in-network doctor or pharmacy.

Where can you get the Medicare-covered pneumonia vaccine?

If you’re over the age of 65, getting your vaccines is an important part of healthy aging—and they also help ensure the health of your friends and family. If you haven’t received your pneumonia or other vaccines, check with your Medicare provider about where you can get them. You can usually receive vaccines at your doctor’s office or at your local clinic or pharmacy.

Need additional help? Check out the HealthMap Vaccine Finder to find all locations near you that offer the pneumococcal vaccine.