Adults 65 and older are recommended to stay current on six key vaccines: influenza (flu), shingles, pneumococcal (pneumonia), COVID-19, RSV, and tetanus-diphtheria. Some of these are one-time shots, others are annual, and the specific formulations matter more than you might expect. As your immune system ages, it responds less robustly to standard vaccines, which is why several of the versions designed for seniors use higher doses or special immune-boosting ingredients.
Why Seniors Need Different Vaccines
Your immune system gradually weakens with age through a process called immunosenescence. The thymus, which produces the immune cells responsible for recognizing new threats, shrinks over time. Chronic low-grade inflammation also increases, which further dulls the body’s ability to mount a strong defense after vaccination. The result: standard-dose vaccines that work well in younger adults may not provide enough protection for someone in their 60s or 70s.
This is why several vaccines now come in senior-specific formulations. High-dose flu vaccines pack more of the active ingredient to compensate for a weaker immune response. Other vaccines include adjuvants, substances that amplify the immune system’s reaction. These aren’t optional upgrades. They’re the preferred versions for this age group.
Influenza: Get a Senior-Specific Flu Shot Every Year
Annual flu vaccination remains one of the most important preventive steps for older adults. The CDC preferentially recommends that people 65 and older receive a high-dose, recombinant, or adjuvanted flu vaccine rather than a standard-dose shot. Studies suggest these formulations are more effective in this age group at preventing flu illness and its complications, which can include pneumonia, hospitalization, and death.
If a high-dose or adjuvanted version isn’t available when you go to get your shot, a standard-dose vaccine is still better than skipping the season entirely. Timing matters too: early fall is ideal, since it takes about two weeks for full protection to develop.
Shingles: Two Doses of Shingrix
If you’ve ever had chickenpox, the virus that caused it is still dormant in your body and can reactivate as shingles, a painful, blistering rash that sometimes leads to weeks or months of nerve pain. The risk rises sharply after 50.
Shingrix, the current shingles vaccine, requires two doses separated by 2 to 6 months. In adults 70 and older, it’s 91% effective at preventing shingles. That’s unusually high efficacy for a vaccine in this age group. You should get Shingrix even if you had the older shingles vaccine (Zostavax, which is no longer available) or if you’ve already had a shingles outbreak, since the virus can reactivate more than once.
Pneumococcal: Protecting Against Pneumonia
Pneumococcal bacteria can cause pneumonia, bloodstream infections, and meningitis, all of which are especially dangerous for older adults. The CDC recommends a pneumococcal conjugate vaccine (PCV15, PCV20, or PCV21) for adults 50 and older who have never received one.
The key detail: if you receive PCV15, you’ll need a follow-up dose of a different pneumococcal vaccine (PPSV23) to broaden your protection. If you receive PCV20 or PCV21, that single vaccine covers a wider range of bacterial strains on its own. If you’re unsure whether you’ve been vaccinated before, your doctor’s office or pharmacy can check your immunization records.
COVID-19: Two Updated Doses for 65 and Older
For the 2025-2026 season, adults 65 and older are recommended to receive two doses of the updated COVID-19 vaccine, spaced about six months apart. If you were previously vaccinated, your first updated dose should come at least 8 weeks after your last shot (or 3 months, depending on the brand). The second dose follows roughly 6 months later.
COVID-19 vaccination for this age group is framed as a shared decision between you and your healthcare provider, meaning it’s recommended but takes your individual health circumstances into account.
RSV: A Single Dose Based on Age and Risk
Respiratory syncytial virus causes cold-like symptoms in most people but can lead to serious lung infections in older adults. The RSV vaccine is a single dose, recommended for all adults 75 and older. If you’re between 50 and 74, you qualify if you have conditions that raise your risk of severe RSV illness.
The list of qualifying conditions is broad:
- Heart disease such as heart failure or coronary artery disease (not isolated high blood pressure)
- Chronic lung conditions including COPD, emphysema, or asthma
- Kidney disease requiring dialysis or other replacement therapy
- Complicated diabetes involving kidney damage, nerve damage, or treatment with insulin
- Neurologic conditions that weaken breathing muscles or impair swallowing
- Liver disease such as cirrhosis
- Severe obesity with a BMI of 40 or higher
- Weakened immune system from disease or medications
- Nursing home residence
You don’t need medical documentation to prove you have a risk factor. Simply telling the vaccinator is considered sufficient.
Tetanus and Pertussis Boosters
Adults need a tetanus-diphtheria booster every 10 years to maintain protection. At least one of those boosters should be Tdap, which also covers pertussis (whooping cough). After that initial Tdap dose, either Td or Tdap can be used for subsequent boosters. Protection against pertussis does fade within a few years of vaccination, but there’s currently no recommendation for repeated pertussis-specific boosters.
Travel Vaccines
If you’re planning international travel, you may need additional vaccines depending on your destination. Hepatitis A, hepatitis B, yellow fever, and typhoid are among the vaccines that might be recommended based on where you’re going and what you’ll be doing. A travel health consultation, ideally 4 to 6 weeks before departure, gives your provider time to review your itinerary and make specific recommendations. Make sure your routine vaccines are current before adding travel-specific ones to the list.
What Medicare Covers
Most recommended vaccines for seniors are covered by Medicare, but they fall under different parts of the program. Medicare Part B (the medical insurance portion) covers flu, pneumonia, hepatitis B for people at increased risk, and COVID-19 vaccines at no cost to you.
Vaccines that prevent illness but aren’t listed under Part B, including shingles, RSV, and Tdap boosters, are covered under Medicare Part D (the prescription drug plan). Coverage and copays for Part D vaccines depend on your specific plan. One nuance worth knowing: a tetanus shot given to treat an injury (like a puncture wound) is covered under Part B, but a routine tetanus booster is a Part D expense.
If you have both Part B and a Part D plan, the vast majority of recommended vaccines will be covered. Pharmacies can typically bill Medicare directly, so you rarely need to pay the full cost upfront.