Vaccination doesn't end in childhood—maintaining up-to-date immunizations throughout older adulthood provides critical protection against serious, preventable infectious diseases. Adults 65 and older face significantly higher risks from many vaccine-preventable diseases due to weakened immune systems, chronic health conditions, and age-related physiological changes. Yet vaccination rates among seniors remain suboptimal, leaving millions unnecessarily vulnerable to influenza, pneumonia, shingles, and other dangerous infections. Understanding which vaccines you need, when to get them, and how they're covered by Medicare empowers you to protect your health and maintain independence throughout your later years.

Why Vaccination Matters More as You Age

Aging fundamentally changes how your body responds to infections. Immunosenescence—the gradual weakening of immune function that occurs with aging—reduces your ability to fight new infections and diminishes vaccine responses. Older immune systems produce fewer antibodies in response to vaccines, generate less robust cellular immune responses, and maintain immunity for shorter periods. This means seniors often need higher vaccine doses, additional doses, or more frequent boosters compared to younger adults.

Despite these age-related immune changes, vaccines remain highly effective at preventing serious illness in older adults. While vaccines may not always prevent infection entirely in seniors, they dramatically reduce disease severity, hospitalization rates, and death. For example, while influenza vaccines may not prevent all flu infections in older adults, they reduce flu-related hospitalizations by 40% and deaths by 40-60% among seniors—protection that saves thousands of lives annually.

The burden of vaccine-preventable diseases falls disproportionately on older adults. Influenza kills 70-85% of seasonal flu-related deaths occur in adults 65+. Pneumococcal disease causes invasive disease in seniors at rates 5-10 times higher than younger adults. Shingles affects 50% of people by age 85, often causing debilitating chronic pain. COVID-19 accounts for 88% of deaths in people over 65. These sobering statistics underscore why vaccination is a cornerstone of healthy aging.

Chronic health conditions—which affect the majority of seniors—further increase vaccine-preventable disease risks. Heart disease, diabetes, COPD, chronic kidney disease, and other common conditions elevate risks of complications from influenza, pneumonia, and other infections. Vaccination provides an extra layer of protection for seniors managing these conditions, helping prevent infectious disease exacerbations that could lead to hospitalization or functional decline.

Beyond individual protection, vaccination contributes to community immunity, helping protect vulnerable individuals who cannot be vaccinated or don't respond well to vaccines. When healthy seniors maintain up-to-date vaccinations, they reduce transmission to frail older adults, immunocompromised individuals, and others at high risk for severe outcomes.

Annual Vaccines: Influenza and COVID-19

Influenza (Flu) Vaccine should be received annually by all adults 65 and older, ideally in September or October before flu season begins. However, getting vaccinated later in the season still provides benefit—flu season can extend into May, so it's not too late to vaccinate even in winter months. The CDC specifically recommends higher-dose or adjuvanted flu vaccines for seniors, as these formulations generate stronger immune responses than standard-dose vaccines.

Three enhanced flu vaccines are recommended for adults 65+: Fluzone High-Dose Quadrivalent contains four times the antigen of standard flu vaccines, generating stronger antibody responses; Flublok Quadrivalent is a recombinant vaccine (made without eggs) that contains three times more antigen than standard vaccines; and Fluad Quadrivalent contains an adjuvant (MF59) that enhances immune response to standard antigen amounts. Studies show these enhanced vaccines reduce flu-related hospitalizations by an additional 12-14% compared to standard-dose vaccines in seniors.

If enhanced vaccines aren't available, standard-dose flu vaccine is better than no vaccine. Don't delay vaccination waiting for a specific brand—the best flu vaccine is the one available to you now. Common side effects include soreness at the injection site, mild body aches, and low-grade fever lasting 1-2 days. Serious allergic reactions are extremely rare.

Important: egg allergy is no longer a contraindication to flu vaccination. People with egg allergy can safely receive any age-appropriate flu vaccine. If you have severe egg allergy (anaphylaxis), vaccination should occur in a medical setting where allergic reactions can be managed, but the vaccine itself is safe.

COVID-19 Vaccine is now recommended annually for all adults 65+, similar to influenza vaccination. The 2024-2025 updated COVID-19 vaccine should be received in fall (September-October is ideal) to provide optimal protection during winter respiratory virus season. The updated vaccine is reformulated each year to target currently circulating variants, providing improved protection compared to previous vaccine versions.

Adults 65+ should receive one dose of the updated COVID-19 vaccine regardless of previous vaccination history. Immunocompromised seniors may benefit from an additional dose 2+ months after the first dose—discuss this with your healthcare provider. COVID-19 vaccines can be given simultaneously with flu and other vaccines. Common side effects include injection site pain, fatigue, headache, and muscle aches lasting 1-2 days. These are generally milder in older adults compared to younger people.

The updated COVID-19 vaccines reduce hospitalization risk by 60-70% and death risk by 80-90% in adults 65+. Given that seniors account for 88% of COVID-19 deaths, annual COVID-19 vaccination provides life-saving protection and should be prioritized alongside annual flu vaccination.

Pneumococcal Vaccines: Critical Protection for Seniors

Pneumococcal vaccines protect against Streptococcus pneumoniae bacteria that cause pneumonia, meningitis, and bloodstream infections. Pneumococcal disease kills thousands of older adults annually despite being vaccine-preventable. All adults 65 and older need pneumococcal vaccination, but the specific recommendations are complex, depending on vaccination history.

Three pneumococcal vaccines are available: PCV20 (Prevnar 20) and PCV15 (Vaxneuvance) are conjugate vaccines that generate strong, long-lasting immunity; PPSV23 (Pneumovax 23) is a polysaccharide vaccine covering 23 bacterial strains but generating weaker immunity. The current CDC recommendations for adults 65+ who have never received pneumococcal vaccine are either one dose of PCV20, OR one dose of PCV15 followed by PPSV23 one year later (or at minimum 8 weeks later if immunocompromised).

PCV20 offers the advantage of single-dose protection, simplifying the vaccination schedule. The PCV15 + PPSV23 sequence provides coverage against a broader range of bacterial strains—PCV15 covers 15 strains with strong immunity, while PPSV23 adds coverage for 8 additional strains, totaling 23 strains of protection. Both approaches are acceptable; discuss with your healthcare provider which makes sense for your situation.

For seniors who previously received pneumococcal vaccines (PCV13 or PPSV23), catch-up recommendations vary based on vaccination history. If you received PPSV23 but never received a conjugate vaccine (PCV13, PCV15, or PCV20), you should receive one dose of PCV20 at least one year after your most recent PPSV23 dose. If you received PCV13 but never received PPSV23, you should receive one dose of PPSV23 at least one year after PCV13 (or one dose of PCV20 at least 5 years after PCV13). If you received both PCV13 and PPSV23, no additional doses are currently recommended, though this may change as new data emerge.

These complex recommendations reflect evolving science about pneumococcal vaccination. If you're uncertain about your pneumococcal vaccination history, ask your healthcare provider to review your records and recommend an appropriate schedule. Side effects of pneumococcal vaccines include pain and redness at the injection site, mild fatigue, headache, and muscle aches lasting 1-2 days. Serious side effects are rare.

Shingles Vaccine: Essential Protection Against Debilitating Pain

Shingrix is recommended for all adults 50 and older to prevent shingles (herpes zoster) and post-herpetic neuralgia. Given the severe, potentially debilitating pain associated with shingles—particularly in older adults—and Shingrix's excellent effectiveness, this vaccine is a high priority for seniors. Shingrix is administered as a two-dose series with doses given 2-6 months apart (minimum 8 weeks). Both doses are necessary for optimal protection.

Shingrix is recommended even if you previously had shingles (you can get shingles more than once), previously received the older Zostavax vaccine (Shingrix is more effective), or don't remember having chickenpox (virtually all adults born in the US before 1980 had chickenpox and carry dormant virus). There's no upper age limit for Shingrix—even adults in their 80s and 90s benefit from vaccination.

Shingrix is more than 97% effective at preventing shingles in adults 50-69 and about 91% effective in adults 70+. Even more important, it's more than 90% effective at preventing post-herpetic neuralgia—the chronic, debilitating nerve pain that affects 25-40% of shingles patients over 60 and can last months or years. Protection remains strong for at least 7 years after vaccination, possibly longer.

Shingrix side effects are more common and more pronounced than most other adult vaccines. Approximately 78% of recipients experience injection site pain, 45% experience muscle aches and fatigue, and 38% experience headaches. About one in six people report side effects severe enough to interfere with daily activities for 1-2 days. Side effects are typically more intense after the second dose. Despite these temporary side effects, the vaccine is safe, and symptoms resolve within 2-3 days.

To manage side effects, take the vaccine in your non-dominant arm, plan rest time for 1-2 days after vaccination, stay well-hydrated, use cool compresses on sore injection sites, and take acetaminophen or ibuprofen if needed. Don't let concern about temporary side effects prevent vaccination—1-2 days of arm soreness and fatigue is far preferable to the excruciating, potentially long-lasting pain of shingles and post-herpetic neuralgia.

Medicare Part D covers Shingrix, though cost-sharing varies by plan. Under the Inflation Reduction Act, cost-sharing for Shingrix and other adult vaccines will be eliminated for Medicare Part D beneficiaries starting in 2025, making the vaccine free for Medicare recipients. Check with your Part D plan about coverage details and which pharmacies offer the best prices.

RSV Vaccine: New Protection for Older Adults

Respiratory syncytial virus (RSV) vaccines are now available for older adults, representing an important new tool for preventing serious respiratory illness. The CDC recommends RSV vaccination for all adults 75 and older, and for adults 60-74 with increased risk of severe RSV disease. Risk factors include chronic lung disease (COPD, asthma), chronic heart disease, weakened immune systems, chronic kidney disease, diabetes, obesity, neurologic conditions, blood disorders, or living in nursing homes or long-term care facilities.

Two RSV vaccines are authorized: Arexvy (GSK) and Abrysvo (Pfizer). Both are given as a single dose and protect against severe RSV disease. Clinical trials showed these vaccines reduce severe RSV-related lower respiratory tract disease by approximately 80% in older adults—substantial protection against a virus that causes 60,000-160,000 hospitalizations annually among seniors.

RSV causes symptoms similar to colds and flu—cough, congestion, fever, fatigue—but can progress to severe pneumonia, bronchiolitis, and respiratory failure, particularly in older adults with underlying health conditions. RSV season typically runs from fall through spring, overlapping with flu and COVID-19 seasons.

RSV vaccine side effects include injection site pain, fatigue, headache, and muscle aches lasting 1-2 days, similar to other adult vaccines. Serious side effects are rare. The vaccine can be given simultaneously with flu and COVID-19 vaccines, though some people prefer spacing vaccines by 1-2 weeks to minimize side effects.

Currently, CDC recommendations specify RSV vaccination as a one-time dose, not an annual vaccine. However, recommendations may evolve as more data accumulate about duration of protection and need for boosters. This is the first year RSV vaccines have been available for older adults, so guidance will likely be refined over time.

Medicare Part D covers RSV vaccines, with cost-sharing dependent on your specific plan. Like other adult vaccines, cost-sharing for RSV vaccines will be eliminated for Medicare Part D beneficiaries starting in 2025 under the Inflation Reduction Act.

Tdap and Td: Tetanus, Diphtheria, and Pertussis Protection

Tdap vaccine protects against tetanus, diphtheria, and pertussis (whooping cough). Adults 65+ should have received one dose of Tdap if they haven't previously received it as an adult. Tdap is particularly important if you'll have close contact with infants under 12 months old, as pertussis can be life-threatening for babies and adults serve as common infection sources.

After receiving Tdap, you need a Td booster (tetanus and diphtheria, without pertussis component) every 10 years. Tetanus is a serious disease caused by bacteria in soil, dust, and manure that enters the body through wounds. While rare due to vaccination, tetanus still occurs and is fatal in about 10% of cases. Maintaining tetanus protection is important, especially for active seniors who garden, do yardwork, or have other exposures to soil and potential wounds.

If you sustain a deep or dirty wound and haven't had a tetanus-containing vaccine within 5 years, you may need a booster sooner than the routine 10-year interval. Inform healthcare providers about wound characteristics and your vaccination history so they can provide appropriate wound care and vaccination if needed.

Tdap and Td vaccines are generally well-tolerated, with side effects including arm soreness, mild fever, and fatigue lasting 1-2 days. Serious allergic reactions are extremely rare. Medicare Part B covers Tdap and Td vaccines at 100% with no cost-sharing when given for wound management, though routine Tdap may be covered under Part D depending on circumstances.

Other Vaccines for Special Circumstances

Beyond routine vaccinations, some seniors need additional vaccines based on health conditions, lifestyle, or travel plans. Hepatitis A vaccine is recommended for adults with chronic liver disease, clotting factor disorders, men who have sex with men, injection drug users, people experiencing homelessness, and those traveling to countries with high hepatitis A rates. The vaccine is given as a two-dose series 6 months apart.

Hepatitis B vaccine is recommended for adults with diabetes under age 60 (and optionally for those 60+), chronic liver disease, HIV infection, chronic kidney disease including dialysis patients, people with sexual risk factors, injection drug users, and healthcare workers. Medicare Part B covers hepatitis B vaccine for people at medium or high risk. The vaccine is typically given as a three-dose series over 6 months, though newer two-dose schedules are available.

Recombivax HB (hepatitis B vaccine) comes in a higher-dose formulation specifically for dialysis patients and immunocompromised individuals who need stronger antigenic stimulation. Discuss with your nephrologist or healthcare provider if this applies to you.

MMR (measles, mumps, rubella) vaccine may be recommended if you lack evidence of immunity (particularly for healthcare workers or those traveling internationally). Adults born before 1957 are generally considered immune to measles, mumps, and rubella. Those born in 1957 or later who lack immunity evidence should receive one or two doses depending on circumstances.

Varicella (chickenpox) vaccine is recommended for adults without evidence of immunity who've never had chickenpox and weren't vaccinated. Given that virtually all current seniors had chickenpox in childhood, this rarely applies to adults 65+. However, if you're certain you never had chickenpox, discuss vaccination with your provider.

Meningococcal vaccines may be recommended for adults with certain medical conditions (complement component deficiency, asplenia) or other risk factors. Routine meningococcal vaccination is not recommended for healthy older adults.

Travel-related vaccines depend on destination and may include typhoid, yellow fever, Japanese encephalitis, rabies, and others. If planning international travel, consult with a travel medicine specialist or your healthcare provider 4-6 weeks before departure to determine necessary vaccinations.

How Medicare Covers Vaccines

Understanding vaccine coverage helps ensure you receive needed immunizations without unexpected costs. Medicare Part B covers certain vaccines at 100% with no deductible, copayment, or coinsurance when provided by participating providers. Part B-covered vaccines include influenza vaccine (flu shot), pneumococcal vaccines, hepatitis B vaccine (for people at medium or high risk), and COVID-19 vaccines and boosters. These vaccines are free regardless of where you receive them—doctor's office, pharmacy, or other healthcare setting.

Medicare Part D covers vaccines not covered by Part B, including Shingrix (shingles vaccine), Tdap and Td vaccines (tetanus, diphtheria, pertussis), hepatitis A vaccine, RSV vaccines, and other vaccines recommended by the CDC. Part D coverage traditionally required cost-sharing (copayments or coinsurance) that varied by plan, though many Part D plans covered these vaccines with no or minimal cost-sharing.

Major changes take effect in 2025: The Inflation Reduction Act eliminates cost-sharing for all adult vaccines covered under Medicare Part D. Starting in 2025, Medicare beneficiaries will receive Part D-covered vaccines including Shingrix, Tdap/Td, hepatitis A, and RSV vaccines at no out-of-pocket cost. This removes a significant financial barrier that prevented some seniors from receiving important vaccines.

To maximize coverage and minimize costs, verify the provider accepts Medicare assignment, confirm which part of Medicare covers the specific vaccine you're receiving, bring your Medicare card and Part D card if receiving a Part D-covered vaccine, and understand that while the vaccine itself is covered, there may be charges for the visit if the appointment includes other services beyond vaccination.

If you're charged for a vaccine that should be covered at 100%, appeal the charge. Sometimes billing errors occur, and vaccines are incorrectly coded or billed. Contact your Medicare plan or call 1-800-MEDICARE for assistance resolving billing issues.

Putting It All Together: Your Vaccination Action Plan

Creating and maintaining an up-to-date vaccination schedule ensures comprehensive protection. Start by reviewing your vaccination history. Request records from healthcare providers, check your state's immunization registry (if available), and note what vaccines you've received and when. Identify gaps based on CDC recommendations for adults 65+.

Prioritize catch-up vaccinations. If you're behind on recommended vaccines, work with your healthcare provider to develop a catch-up schedule. Most vaccines can be given simultaneously, accelerating catch-up timelines. High-priority vaccines to catch up on include Shingrix (if you've never received it), pneumococcal vaccines, COVID-19 and influenza (annually), and RSV vaccine (if you meet age or risk criteria).

Schedule annual vaccines in early fall. Make it a routine to receive your flu and COVID-19 vaccines each September or October. Many pharmacies and healthcare providers offer convenient same-day administration of both vaccines. Consider adding RSV vaccine during the same visit if you haven't previously received it and meet criteria.

Set reminders for multi-dose vaccines. Shingrix requires two doses 2-6 months apart. Some pneumococcal schedules require two different vaccines one year apart. Set calendar reminders or ask your healthcare provider's office to send reminders when subsequent doses are due.

Keep personal vaccine records. Maintain a personal record of all vaccines received including vaccine name, date, and provider. Take a photo of your vaccine card and store it digitally for easy access. Share your vaccination history with all healthcare providers to ensure accurate recommendations.

Vaccinations represent one of the most effective preventive health measures available to older adults. By maintaining up-to-date immunizations, you dramatically reduce your risk of serious, potentially life-threatening infections and preserve your health, independence, and quality of life throughout your later years. Don't let gaps in vaccination leave you vulnerable to preventable diseases—work with your healthcare team to ensure you're fully protected according to current CDC recommendations for adults 65 and older.