There is a flu shot this year that you could not get last year. It is the first flu shot made with the same mRNA technology as the COVID vaccines, it is approved for adults 50 and older, and it is supposed to reach pharmacies this fall. The pharmacy ads do not explain what it is, whether you need it, or what it costs. Neither is the news, which is busy arguing about who gives vaccine advice instead of telling you what to do. So here is the plain list: the shots worth asking about this fall, who each one is for, when to get it, and what it costs - because under Medicare, most of it costs nothing.
I am not a doctor, and this is not advice for your specific health. It is the list I wish someone had handed me last September, when I stood at the pharmacy counter trying to remember which shots I had already had. There is a system to it, and once you see it, it is simple.
The List, Up Front
Five shots to know about, and only three of them come around every year. Here is the whole thing in one breath, and then we will take them one at a time:
- Flu: every year, ideally September or October.
- COVID: every year with the updated shot - and if you are 65 or older, a second dose about six months after the first.
- RSV: once, ever. The window to get it is right now.
- Shingles: two doses, once in your life, recommended starting at 50.
- Pneumonia: usually one dose, once in your life, at 65 or older.
The Flu Shot, Including the Brand-New One
The flu is not a bad cold. For people our age it is one of the most common reasons a healthy autumn turns into a hospital stay, which is why the yearly shot is worth the ten minutes. But this year there is real news attached, and it comes with a caveat.
In August, the FDA approved the first mRNA flu shot. Moderna makes it, it is called mFlusiva, and it works the same way the COVID shots do: instead of a dead virus or a piece of protein, it hands your body instructions for recognizing the flu, and your body does the rest. It is approved for adults 50 and older.
Why should you care? In the company’s study of adults 50 and up, the mRNA shot was about 27 percent more effective than the standard shot at preventing flu illness. That is a real difference. The caveat is the one the COVID shots taught us: more mild side effects. A sore arm, a day of tiredness, some achiness - the signs your immune system is working. They pass in a day or two.
Here is what the groups that set the guidance say. For everyone 65 and older, the preference is an “enhanced” flu shot when one is available - high-dose, adjuvanted (that means it has a booster built in), recombinant, or the new mRNA one. But every one of those groups says the same thing: do not delay getting vaccinated just to hunt for the fancy version. The standard shot is far better than no shot, and October is not the time to be waiting on a restock.
If you are between 50 and 64, you can ask for the mRNA shot and see if your pharmacy has it. If it does not, get the standard one. The best flu shot is the one you can get this week, not the one you read about.
One thing to cross off your worry list: the shot cannot give you the flu. It does not contain a live virus. A sore arm and a tired day are common and mean it is working.
The COVID Shot: A Two-Part Story Now, for 65 and Up
The COVID shot is on the same yearly rhythm as the flu shot now. A new formula was approved in August for this season, aimed at the strains expected this winter, and one dose is recommended for most adults. Get it at the same visit as your flu shot and the trip is done.
The new detail this year is for people 65 and older: the recommendation is a second dose about six months after the first. The reason is simple: protection fades, older immune systems need a reminder sooner, and six months puts the second dose in late winter, when the season usually peaks. So if you are 65 or older, get the first dose with your flu shot this fall, then put a note on the calendar for six months out.
The RSV Shot: The One-Time One, and the Window Is Now
RSV (Respiratory syncytial virus) is the quiet one. It is a plain cold-like virus in children, but in older adults it is one of the biggest causes of winter hospitalizations, and most people have never heard of the shot that prevents it. It is a one-time shot - not yearly, not boosted. The Centers for Disease Control and Prevention recommends it for everyone 75 and older, and for adults 50 to 74 who have health conditions that raise their risk: heart disease, lung conditions like COPD or asthma, diabetes, a weakened immune system. The pharmacist has the full list and can tell you in ten seconds whether you are on it.
The timing matters. The shot takes a couple of weeks to build protection, and RSV season starts in the fall. That makes late summer and early fall - right now - the window. If you got the shot in a past year, you are done. No booster, no annual reminder. If you have not, this is the month to make the call.
While You Are There: Shingles and Pneumonia
Since you will be at the pharmacy anyway for the seasonal shots, there are two once-in-a-life questions worth asking in the same visit.
Shingles. Shingles is the chickenpox virus waking up decades later, and it is miserable: a painful rash that can leave nerve pain lasting months or years. Two close friends have had it in the past few years - both described it as incredibly painful and unpleasant.
The risk climbs with age, which is why the vaccine is recommended for everyone 50 and older - and yes, if you had chickenpox as a child - and most of us over 50 did - you are exactly who it is for. It is two doses, a few months apart, and this is worth knowing: if you started the series, finish it. The second dose is what makes the protection stick.
Pneumonia. The pneumonia shot prevents the most common bacterial kind, and for most people it is one dose, once, at 65 or older. Some younger adults with health conditions are due earlier. There are a few versions now, and the dosing depends on your history, so the question is not “which one” - it is “have I had mine, and am I due?” The pharmacist can often check your records and answer on the spot.
What It Costs: The Part B and Part D Surprise
This is where people get needlessly scared off, so let me be plain about it.
Under original Medicare, the flu shot, the COVID shot, and the pneumonia shot are Part B - the medical side - and they cost nothing when you get them at a pharmacy or doctor that accepts Medicare.
The surprise is RSV and shingles. They do not run through Part B. They run through Part D, your drug plan. That sounds like a bill, but a few years ago the law changed so that Part D covers every recommended adult vaccine with nothing out of pocket. Medicare’s own site says it in one line: you pay nothing for the RSV vaccine if you have Part D. Same for shingles. So the answer, for all five shots on this list, is the same: nothing, at a pharmacy in your plan’s network.
If you have a Medicare Advantage plan, the shots are covered too, but the details differ slightly by plan. The one question to ask: “Is this shot covered, and what will it cost me?” Ask it before you roll up your sleeve, and you will never be surprised. No Medicare at all? Most insurance cover recommends vaccines at no cost - ask the same question.
One Trip, One Card
Here is the part I love. You do not need five separate appointments for this list. A pharmacy can give you flu, COVID, and RSV in one visit, and answer the shingles and pneumonia questions while you are there. One trip covers the whole list.
Bring your medicine list with you. The pharmacist checks every vaccine against what you take, which makes it the perfect moment for the medication review that matters before Falls Week.
Then take the record card. Ask for the printout or the little card that lists what you got and when, and put it in the folder your family hopes you have. That is the fix for the exact problem I had last September, standing at the counter unable to remember whether I had already had my RSV shot. Do this, and next year, you will not be guessing.
What to Do Now
- If you are 75 or older, or 50 to 74 with a health condition, call your pharmacy this week about the RSV shot. It is one-time, it is free under Medicare, and the window is open right now.
- Book your flu shot for late September or October. If you are 65 or older, ask for the high-dose, adjuvanted, or mRNA version. If you are 50 to 64, ask about the new mRNA shot. If your pharmacy does not have it, take the standard shot and do not wait.
- Get the updated COVID shot in the same visit. If you are 65 or older, put a reminder on the calendar for six months out - that second dose is part of the recommendation now.
- Ask the two once-in-a-life questions while you are there: have I started or finished my shingles shots, and have I had my pneumonia shot?
- Take the record card home and put it in the folder. Next September, you will walk in knowing exactly where you stand.
The shots are one of the rare health tasks where the doing takes less time than the worrying about it. The whole list is one pharmacy trip, one set of questions, and a card that goes in a folder. Your grandmothers did not get this list handed to them - they had to keep it in their heads and hope. You get to do better, and it starts with one phone call this week.
Disclaimer: I am not a doctor. I am a grandmother who has had to figure this out the hard way - the pharmacist who knows my name, the record card I finally started keeping, the questions I learned to ask. This article is the plain-language list, not medical advice. Check with your doctor or pharmacist about what is right for you, especially if you have health conditions or take prescription medicine.
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