If you’re 65 or older and have never received a pneumococcal conjugate vaccine, the CDC recommends getting one now. You have three options: PCV15, PCV20, or PCV21. Any of these will protect you against the bacterial infections that cause pneumococcal pneumonia, bloodstream infections, and meningitis. The choice between them comes down to how many shots you want and how broad the coverage is.
Your Three Vaccine Options
Pneumococcal vaccines work by training your immune system to recognize specific strains (called serotypes) of the bacterium that causes pneumococcal disease. The more serotypes a vaccine covers, the broader your protection. Here’s how the current options break down:
PCV20 is a single-shot option that covers 20 serotypes. Because it offers broad coverage in one visit, it’s the most straightforward choice for most people over 65. You get one injection and you’re done.
PCV21 is also a single-shot option and the newest of the three. It covers 21 serotypes, making it the widest-coverage conjugate vaccine currently available.
PCV15 covers 15 serotypes, which is narrower than PCV20 or PCV21. To close that gap, the CDC recommends following PCV15 with a dose of PPSV23, a different type of vaccine that covers 23 serotypes. That second shot should come about one year later. So choosing PCV15 means committing to a two-dose series.
All three conjugate vaccines (PCV15, PCV20, PCV21) use the same basic technology. They attach pieces of the bacterial coating to a carrier protein, which produces a stronger and longer-lasting immune response than older vaccine types. The key difference is simply how many strains each one targets.
One Shot or Two?
The practical decision for most people over 65 is whether to get a single vaccine (PCV20 or PCV21) or the two-dose PCV15-plus-PPSV23 series. Both approaches provide strong protection.
If you prefer simplicity, PCV20 or PCV21 lets you walk out of the pharmacy with your pneumococcal vaccination complete. If your provider has PCV15 available and you don’t mind returning for a second shot, that combination also works well. The second dose of PPSV23 is given at least one year after PCV15. For people with weakened immune systems, cochlear implants, or cerebrospinal fluid leaks, that interval can be shortened to a minimum of eight weeks.
What If You Already Got a Pneumonia Vaccine
Your vaccination history matters. Many adults over 65 received an older vaccine, PCV13, or a dose of PPSV23 years ago. If that’s you, the path forward depends on exactly what you received and when.
If you previously got both PCV13 (at any age) and PPSV23 (at age 65 or later), you already have meaningful protection. Getting PCV20 or PCV21 on top of that is optional. The CDC frames this as a shared decision between you and your provider, based on your health status and risk factors.
If you received PPSV23 before age 65 but never got a conjugate vaccine, you likely still need one. Talk to your provider about getting PCV20 or PCV21 now. There’s typically a waiting period of at least one year after your last PPSV23 dose before receiving a conjugate vaccine.
If you have no idea what pneumonia shots you’ve had in the past, your doctor’s office or pharmacy may have records. When in doubt, getting vaccinated is generally safe even if you’ve had a prior dose.
Side Effects Are Mild for Most People
The most common reactions to pneumococcal conjugate vaccines are soreness, redness, and swelling at the injection site. Some people also experience fatigue, headache, muscle pain, joint pain, or chills. These side effects tend to be mild to moderate and resolve within a few days.
Clinical trials in older adults found that injection site reactions and general symptoms like muscle aches were more common in people who received the conjugate vaccine compared to placebo, but the vast majority were not severe. PPSV23 causes similar side effects. Serious allergic reactions are rare and are mainly a concern for people with a known allergy to any component of the vaccine or to diphtheria-containing vaccines.
Medicare Covers the Full Cost
Medicare Part B covers all recommended pneumococcal vaccines at no cost to you, as long as your provider accepts Medicare assignment. You pay nothing out of pocket for the shot itself. This applies to both doses if you’re getting the PCV15-plus-PPSV23 series. Most private insurance plans for people over 65 also cover pneumococcal vaccination without a copay, since it’s classified as a preventive service.
You can get vaccinated at your doctor’s office, a pharmacy, or a community health clinic. If you’re scheduling a routine visit or picking up a flu shot, it’s a good time to ask about pneumococcal vaccination as well, since these vaccines can often be given at the same appointment as other shots.