Every fall for as long as I can remember, the drill was simple. The Centers for Disease Control and Prevention told you which shots to get, your doctor or pharmacist gave them to you, and you moved on with your life.
This year the drill broke.
The federal committee that normally writes those recommendations has been frozen by a lawsuit since March, and it hasn’t issued a single new recommendation for the 2026-27 season. So on Sept. 2, four of the country’s largest physician groups did something they’ve never had to do: They published their own.
The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists and the Infectious Diseases Society of America released joint guidance based on an independent review of the evidence run out of the University of Minnesota.
I’m not a doctor. But I’ve spent 35 years sorting reliable information from noise, and here’s my read: This is the closest thing to a straight answer you’re going to get this fall.
So let me lay out what it says for people 50 and older, and what it’ll cost you. (Spoiler: You’ll pay nothing if you’re on Medicare.)
If you’re 50 to 64
Flu: Get your annual shot, ideally in September or October. That timing comes straight from the CDC, which did extend last year’s flu guidance into this season even though everything else is stuck.
All three strains in this year’s formula have been updated, including one aimed at the H3N2 variant that spread widely last winter.
COVID: The physician groups recommend one dose of the updated 2026-27 vaccine for every adult. The FDA approved the new formula in late August.
One catch: the FDA labels for people under 65 cover only those with an underlying health condition, and the list of qualifying conditions is long. Ask your pharmacist.
Respiratory syncytial virus, or RSV: If you have a chronic condition — heart disease, lung disease, diabetes, a weakened immune system, among others — you should get the RSV vaccine. It’s a one-time shot, not an annual one, and the CDC agrees on both points.
Two more that weren’t part of the Sept. 2 announcement but that the CDC already recommends at 50: the two-dose shingles vaccine, which is more than 90% effective, and a pneumococcal vaccine, now recommended for everyone 50 and up.
If you’re 65 to 74
Everything above applies, with two upgrades.
First, don’t settle for the regular flu shot. The physician groups say people 65 and older should get an enhanced version of the flu vaccine, such as:
- High-dose
- Adjuvanted
- Recombinant
- mRNA (new this year)
The CDC’s existing guidance says the same about the first three.
Your immune system responds less vigorously as you age, and these formulations are built to compensate.
Second, plan on two COVID doses. The groups recommend a second shot of the updated vaccine six months after the first. This is the biggest difference from what you may have heard before, and it’s aimed squarely at your age group, because protection fades with time.
RSV still depends on risk factors at this age. Talk to your doctor if you have one of the conditions above.
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If you’re 75 or older
Everything above, plus RSV becomes universal. At 75, the recommendation is that everyone gets the one-time RSV vaccine, healthy or not.
The reason is in the numbers.
CDC data for the most recent full season show people 75 and older were hospitalized for COVID at more than three times the rate of those 65 to 74, and RSV put roughly 427 of every 100,000 people in the 75 and older age group in the hospital.
More than 8 in 10 RSV deaths and nearly 9 in 10 COVID deaths were in people 65 and up.
If you got the RSV shot in 2024 or 2025, you’re done. The CDC says one dose protects for at least two years, and there’s no recommendation for a repeat yet.
Can I get them all at once?
Yes. The CDC says flu vaccine can be given at the same visit as other vaccines, and the University of Minnesota review found no increased risk of serious side effects when flu is paired with COVID or RSV.
If you’d rather not have a sore arm on both sides, spacing them a week or two apart is fine too. What you shouldn’t do is let scheduling friction push you into November.
What it costs
As I said before, if you’re on Medicare, it costs you nothing. Flu, COVID and pneumococcal shots are covered under Part B with no copay — they’re among the things that are free with Medicare that too few people use.
Shingles and RSV are covered under Part D, and since 2023 you pay nothing for those either — a change that took a shot many people used to pay for out of pocket down to $0.
If you have private insurance, the major insurers have committed to covering every vaccine that was recommended as of last September with no cost-sharing through the end of 2027. That covers flu, COVID, RSV, shingles and pneumococcal.
One wrinkle to watch. Last fall, some pharmacy chains in a handful of states required a doctor’s prescription for a COVID shot because of the federal confusion.
Most states have since cut that tie, but a few holdouts remain. If your pharmacy turns you away, call your doctor’s office and ask for a prescription or a standing order. Don’t just give up.
Who to listen to
I understand the instinct to sit this year out. When the government’s own experts are in court instead of in a conference room, it’s tempting to wait for the dust to settle.
But the viruses don’t wait, and vaccines take a couple of weeks to build protection, which is why the CDC keeps saying September or October.
The doctors who’ll be treating you in the ER this winter just told you, in writing, what they think you should do — and it’s essentially what they’ve told you every year.
Get the shots. Get the stronger flu shot if you’re 65 or older. Get the RSV shot if you’re 75 or older, or you have a chronic condition. And get them this month, while they’re free, available and still your decision to make.
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