COVID-19 vaccines are now recommended for everyone 6 months and older, but certain groups are prioritized more urgently than others. The CDC emphasizes that adults 65 and older, people with high-risk medical conditions, residents of long-term care facilities, and those who have never been vaccinated should be first in line for the latest updated vaccine.
Who Should Get Vaccinated First
The CDC’s current guidance uses an “especially important” framework rather than a strict rollout order. Unlike the early days of the pandemic, when vaccines were scarce and distributed in rigid phases, supply is no longer the bottleneck. Instead, the priority is about medical urgency. The people at greatest risk of hospitalization and death benefit most from staying current.
The groups the CDC flags as highest priority are:
- Adults 65 and older: This is the only age group recommended to receive two doses of the updated vaccine, spaced six months apart. Everyone else typically needs just one.
- People at high risk for severe COVID-19: This includes anyone with conditions like diabetes, heart disease, chronic kidney or liver disease, cancer, obesity, HIV, lung conditions such as asthma or COPD, pregnancy, or a weakened immune system.
- Residents and staff of long-term care facilities: Congregate living settings carry higher transmission risk, and residents tend to be older or medically vulnerable.
- People who have never received any COVID-19 vaccine: Without any prior immune priming from vaccination, this group has the least protection against severe illness.
- Pregnant people: Pregnancy increases the risk of severe COVID-19, and vaccination during pregnancy also passes some protection to the newborn.
Why Adults 65 and Older Get Extra Doses
Older adults are the only group recommended for two doses of the updated vaccine each year, with six months between them. The minimum interval can be shortened to two months if timing matters, for instance before a winter COVID surge or a planned trip. This extra dose reflects the reality that immune responses weaken with age, and older adults account for the vast majority of COVID-19 deaths.
Immunocompromised People Have a Different Schedule
People who are moderately or severely immunocompromised, whether from organ transplants, certain cancers, autoimmune medications, or other causes, follow a more intensive vaccination schedule. They are also recommended to receive at least two doses of the updated vaccine, spaced at least two months apart. After completing those doses, they can get additional doses in consultation with a healthcare provider. No documentation is required to confirm immunocompromised status; self-reporting is accepted.
This group’s immune systems may not mount as strong a response to a single dose, so the extra shots help build a more reliable layer of protection.
How Children Are Prioritized
Children 6 months and older are eligible, but in May 2025 the federal guidance shifted to “shared clinical decision-making” for healthy children and adolescents aged 6 months through 17 years. That means the decision is made between parents and their child’s doctor rather than being a blanket recommendation for every healthy child.
Young children who have never been vaccinated need a multi-dose initial series: three doses of the Pfizer vaccine or two doses of the Moderna vaccine for kids under 5. Children 5 and older who are starting fresh need just one dose of the updated vaccine. The youngest children receive a smaller dose volume (0.3 mL for the Pfizer version, compared to higher amounts for older kids and adults).
How This Differs From the Original Rollout
When COVID-19 vaccines first became available in December 2020, the U.S. used a strict phased system because supply was extremely limited. Healthcare workers and nursing home residents went first (Phase 1a), followed by people 75 and older and essential workers (Phase 1b), then people with high-risk conditions and those 65 to 74 (Phase 1c). The general public had to wait months.
That phased system no longer applies. Vaccines are widely available at pharmacies, clinics, and health departments. The current framework is less about “who can get vaccinated” and more about “who benefits the most.” Anyone 6 months or older can walk in and get a dose, but the CDC’s messaging puts vulnerable groups at the front of the line in terms of urgency.
Access for Uninsured Adults
The CDC’s Bridge Access Program, which previously provided free COVID-19 vaccines to uninsured adults, ended in August 2024 when the updated vaccines replaced the older formula. Uninsured individuals can now seek vaccines through state and local health department immunization programs, though availability varies by location. Most private insurance plans and Medicare cover the cost of COVID-19 vaccination with no out-of-pocket expense.