Aug. 29, 2025 – A COVID-19 wave is underway, flu shot ads are reappearing at pharmacies and doctors' offices, and fall vaccine season is here – along with fresh confusion.
On Wednesday, the FDA approved the updated COVID vaccines for adults who are 65 or older and people with medical conditions that put them at high risk of severe illness, raising fresh questions about access and insurance coverage for healthy Americans under 65.
The announcement follows a major shift in federal guidance earlier this year: For COVID vaccines, the CDC now recommends "shared clinical decision-making" for healthy children – leaving the choice to families and their providers – and offers no specific guidance for pregnant people, although pregnancy is included on the list of high-risk conditions. Those moves drew strong pushback from medical organizations, which continue to recommend COVID boosters for pregnant people and for children under 2, as well as baseline vaccination for 6-month-old babies.
Yet, despite the changing headlines and conflicting signals, the core message for most people this fall remains:
- Older adults (65-plus): Your game plan hasn't changed – get a flu shot, a COVID booster, and possibly a respiratory syncytial virus (RSV) vaccine if you haven't had one already.
- People with high-risk medical conditions: You're also strongly encouraged to stay up to date with COVID boosters and flu shots, and you should consider RSV protection.
- Healthy adults under 65 (and healthy older children): COVID boosters are not routinely recommended but should be available to you if you want extra protection. But the new FDA decision means you may need to get the vaccine "off label," a common practice used by doctors and recognized by the FDA for prescribing FDA-approved drugs for non-approved uses. The flu vaccine is still recommended for nearly everyone, healthy people included.
In short: The headlines may be confusing, but your fall vaccine plan doesn't have to be. Here's what matters most.
Children 2-17
COVID: For healthy kids who've already received the primary series of shots, whether or not to get a booster is a conversation to have with their doctor. The American Academy of Pediatrics recommends boosters for children who are regularly around someone at high risk of severe COVID, such as cancer patients or older grandparents. With COVID currently on the rise, it's fine for kids to get a booster now, even though the updated 2025-26 formulation may not have quite reached pharmacies and doctors' offices yet, said Molly O'Shea, MD, a general pediatrician with a private practice outside Detroit.
Flu: Everyone should get a flu shot, but wait until October. "We say flu before boo," O'Shea advised, meaning kids should get their jab before Halloween so protection will peak during the height of flu season. Last year was a particularly dangerous flu season, with 270 pediatric deaths. Among children whose flu vaccination status was known, 90% of those who died were unvaccinated.
What a pediatrician says: Flu is universally a serious risk for kids of any age, but "we've learned over time that COVID infection in children tends to be pretty mild" – assuming they've already been exposed to the virus through vaccination or prior infection, O'Shea said. But keep in mind, severe illness, though rare, can still happen in previously healthy children, and so can long COVID. O'Shea plans to recommend COVID boosters for all children whose parents are open to it.
Babies up to 23 Months Old
COVID: The American Academy of Pediatrics recommends baseline COVID vaccination for babies at the 6-month checkup, and then a booster heading into fall as long as it's been at least eight weeks since the child's last COVID shot.
Flu: Fall flu shots are recommended starting at 6 months old. Those getting it for the first time may need two doses spaced four weeks apart, because the first dose primes the immune system and the second brings the child to full protection.
RSV: Most babies and some toddlers should get an antibody treatment (clesrovimab or nirsevimab). The CDC says babies up to 8 months old should get antibodies if the mother didn't get an RSV vaccine during pregnancy. RSV antibodies should also be given to those up to 19 months old who have certain health conditions, including some lung diseases or cystic fibrosis.
During Pregnancy
COVID: If you're pregnant or planning to be, the American College of Obstetricians and Gynecologists recommends getting the updated COVID booster. Same goes for anyone who has recently given birth or is breastfeeding.
Flu: A flu shot is recommended during any trimester of pregnancy, and it's ideally given in September or October.
RSV: All pregnant people should get the maternal RSV vaccine in order to pass protection to their baby. The vaccine is given between weeks 32 and 36 of pregnancy, September through January, and if you get this vaccine, your baby won't need to get the antibody injection at birth.
Adults Ages 18-64
COVID: If you have conditions including diabetes, heart and lung problems, and obesity, you should get a fall COVID booster (or baseline vaccination if you don't already have it). If you're generally healthy, a fall booster is not routinely recommended but still available to you through shared clinical decision-making if you want the extra protection.
Flu: Everyone should get a flu shot, and October is the optimal time so protection peaks during the height of flu season. If it's more convenient, get your flu shot in September.
RSV: If you're age 50 to 64 and have heart or lung disease, live in a nursing home, are immunocompromised, or have any of these conditions, it's recommended that you get the RSV vaccine. This is not an annual vaccine – you only get it once.
A pharmacist says: "If you haven't been vaccinated against COVID maybe in a couple of years, since the shots first came out, or ever, you're encouraged to go ahead and get that now," said Brigid Groves, PharmD, MS, vice president for professional affairs at the American Pharmacists Association. Healthy adults who are regularly around immunocompromised patients should also consider getting the updated shot, she said.
An infectious disease doctor says: "What's different this year," said Harvard Medical School professor Paul E. Sax, MD, "is there's an increased realization that COVID has a particular seriousness for certain populations in particular – older people and people who have underlying medical conditions that make respiratory infections worse." Focusing COVID vaccination on these high-risk groups "brings us more in line with what the rest of the world is doing, in particular Europe and Australia and Canada."
That said, healthy young adults and children "shouldn't be discouraged from getting [the COVID vaccine] if they want to get it," said Sax, who is the clinical director of the Division of Infectious Diseases at Brigham and Women's Hospital in Boston. "The vaccines are by and large safe, but I do not feel the urgency of recommending the vaccine to that [healthy and younger] group that I did, for example, in 2021."
Adults Ages 65 and Older
COVID: You should get a COVID shot at least twice per year, and if you haven't had one in the last couple of months, you should go ahead and get one now because COVID activity is rising. Don't wait until later this fall or closer to the holidays, said Sharon Brangman, MD, chair of the Department of Geriatrics at Upstate Medical University in Syracuse, New York. "Get it now," she said.
Flu: Everyone age 65-plus should get a flu shot, and October is the optimal time so protection peaks during the height of flu season. Older people should get a high-dose flu shot.
RSV: If you're age 65 to 74 and have heart or lung disease, live in a nursing home, are immunocompromised, or have certain other conditions, it's recommended that you get the RSV vaccine. Everyone ages 75 and older should get the RSV vaccine. This is not an annual vaccine – you only get it once.
A geriatrician says: "People do get nervous about taking all of these vaccines and what it's doing to their body, but in general, our immune system can handle it," Brangman said. "And it's better to take the vaccine than to get sick. These vaccines may not always give you 100% protection, but they will keep you from getting very sick should you get exposed. … Especially as you get older, any exposure to a virus can be such a stress on your system that your body has a hard time fighting it."
Will You Be Able to Get the COVID Vaccine?
Drugmakers said updated COVID vaccines are shipping right after Wednesday's FDA action. But if you usually get your COVID shot at a pharmacy, you should call ahead to make sure you can still get it there. That's because the changing federal recommendations may impact pharmacists' authority to give COVID vaccines in some states, said Groves, noting that 18 states – Colorado, Connecticut, Georgia, Iowa, Kentucky, Maine, Maryland, Massachusetts, Montana, Nevada, New Jersey, New Mexico, North Carolina, Oregon, Pennsylvania, South Carolina, Virginia, and West Virginia – as well as Washington, D.C., are already grappling with interpreting regulations that hinge on CDC recommendations.
If you're not eligible under the new FDA approval but want a vaccine, your best bet may be to visit a doctor's office. Health and Human Services Secretary Robert F. Kennedy Jr. said in an X post Wednesday that COVID "vaccines are available for all patients who choose them after consulting with their doctors." You may need your doctor to prescribe the vaccine off label.
If you're immunocompromised, the CDC website states that you can "self-attest" to that status and receive the COVID vaccine wherever it's offered. "Vaccinators should not deny COVID-19 vaccination to a person due to lack of documentation," the CDC site says.
If you're pregnant, talk to your doctor. Federal guidelines are contradictory. (Pregnancy is on the CDC's list of high-risk conditions, but the agency in May stopped recommending the vaccine during pregnancy.) But the advice from the American College of Obstetricians and Gynecologists is clear: You should get the shot.
Will Insurance Cover the COVID Vaccine?
Reports on insurance coverage vary. In a statement, Kaiser Permanente said it's reviewing the details of the FDA's new approval and will also review the CDC's clinical guidance when it's released along with recommendations from medical societies. The health insurer, which is one of the largest in the U.S., added: "Vaccination continues to be one of the safest and most effective ways to protect against illness and reduce the severity of illness from COVID. Kaiser Permanente is committed to making the 2025-26 COVID vaccine available at no cost to children and adults for protection from severe illness from COVID."
A statement from Blue Cross Blue Shield was even less clear: "A cornerstone of better health is prevention, which includes vaccines. All Blue Cross and Blue Shield plans provide access to preventive services to promote better health and continued well-being for every American we cover. We will continue to monitor and follow all federal immunization guidelines. As always, each independent Blue Cross and Blue Shield plan will make their own coverage decisions."
For now, it appears that many insured Americans – especially older adults or those at high risk – can still get COVID vaccines at no cost.
