What to Know About Getting a COVID-19 Vaccine This Fall

There have been a few cases where the committee’s recommendations — which shape not only the national immunization schedule but also insurance coverage — have differed from FDA labeling, according to a report from the Congressional Research Service.

It’s unclear what the current ACIP will recommend. The panel was recently overhauled: All 17 members were replaced by 7 new appointees selected by Health and Human Services Secretary Robert F. Kennedy Jr.

What are the health conditions that increase your risk of severe COVID-19?

There is a long list of health conditions that the CDC says can increase a person’s risk of severe illness from a coronavirus infection. The list includes asthma, cancer, heart disease, obesity, physical inactivity, depression and smoking, among others.

“More than half of adults meet one of these conditions,” says Dr. Kawsar Talaat, an associate professor in the department of international health at the Johns Hopkins Bloomberg School of Public Health. “Which is why the [previous] ACIP recommended universal vaccination — because half of people meet these conditions,” and nearly everyone knows someone who is at greater risk of complications if they get COVID-19, she says.

Where can I get a COVID vaccine this year?

While doctors’ offices will stock the vaccine, about 90 percent of COVID-19 shots given in the U.S. during the 2024-2025 season were administered in pharmacies; the same is true for the 2023-2024 season, federal data shows.

But any new vaccine restrictions will make it trickier for everyone to walk into their nearest drugstore and roll up a sleeve for a jab.

“Pharmacy rules are set by states, and they vary,” explains Dr. Robert H. Hopkins Jr., medical director of the National Foundation for Infectious Diseases (NFID). “In some states, pharmacists can only follow federal public health recommendations. In other states, they have more flexibility. Once ACIP makes its recommendations later this month, things should become clearer.”

Until then, states and pharmacies are “operating in a gray zone,” says Jigar Mehta, a pharmacist and manager of outpatient pharmacy operations at Beth Israel Lahey Health Pharmacy at Beth Israel Deaconess Medical Center in Boston.

In some states, people under age 65 who want a COVID vaccine can self-attest to their underlying conditions. Pharmacies in other states require a prescription from a physician to indicate that patients are eligible for the vaccine under its narrowed FDA approval. And the vaccine is currently not available at major retail pharmacies in a few states, though this list is changing daily as more states step in to broaden access.

“My advice is to check with a trusted health care professional, such as your own physician or local pharmacist. They will know how it works in your state or local community,” Hopkins says. 

If ACIP decides not to broadly recommend the vaccine for people under 65 and only makes it available to a more restricted population, confusion will persist — “there’s no question,” says Dr. Rebecca Wurtz, an infectious disease physician and professor at the University of Minnesota School of Public Health.

She and others worry that this confusion, combined with added hurdles like needing a prescription before booking a pharmacy appointment, could discourage people from getting vaccinated.

“Any barrier that you put in front of someone — having to call a physician’s office and ask if a person qualifies, having to call an insurance company, having to go to the pharmacy with uncertainty about whether you’re actually going to get the vaccine when you get there — all of those hoops will decrease the rate of vaccination,” Wurtz says.

These extra steps also make it more challenging for people who don’t have a primary care physician they can easily call or visit, Talaat says. “It increases the hardship if pharmacies require prescriptions. How are people who can’t get to their doctors going to get prescriptions?” she says.

Lower vaccination rates this year could mean “more people are ill that didn’t have to be ill, more people in the hospital that possibly could have been prevented and more people dying,” says Dr. Pamela Rockwell, a clinical professor of family medicine at the University of Michigan Medical School.

What if I am not eligible for the vaccine and want one?

Adults under 65 with no underlying conditions should talk to their doctor. Noel Brewer, a distinguished professor in public health and a professor of health behavior at the University of North Carolina, points out that adults 50 to 64 are still at “substantially higher risk of hospitalization.” Parents who want their children vaccinated should talk to their doctor as well.

Several leading medical organizations continue to recommend that most people stay up to date with the COVID vaccine, and it’s likely many physicians will follow that guidance and offer the vaccine off-label to those who are not included in the official recommendations. But it’s not yet clear what advice insurers will follow. (See below for more information.)

States are implementing their own measures to ensure that people who want a COVID vaccine can get one. For example, Massachusetts announced on Sept. 4 that it will require pharmacies to provide the COVID vaccine for people age 5 or older and that insurance carriers in the state must continue to cover vaccines recommended by the Massachusetts Department of Public Health “and not rely solely on CDC recommendations.”

New Mexico is also taking steps to make the COVID-19 vaccine more readily available in pharmacies, and other states are expected to follow.

“For folks who are not sure, the best thing to do is to contact their doctor or health care provider. Their job is to keep up to date on all this stuff,” says Brewer, a former ACIP member. “And if you don’t have access to a health care provider, then contact your local public health clinic.”

Will insurance cover my shot?

Most insurers are required to cover vaccines recommended by ACIP, but recommendations for this year’s COVID-19 vaccine have yet to be issued.

If ACIP recommendations for the vaccine mirror the FDA’s more limited approvals, it will be up to individual insurers — or state policies — to cover the vaccines for healthy people under the age of 65.

“I have to say that it is in the insurers’ best interest to pay for the vaccine that will prevent hospitalizations, severe illness and long COVID, because that will save them money in the long run,” Talaat says.

Preliminary estimates from the CDC show that from Oct. 1, 2024, through June 7, 2025, there were between 270,000 and 440,000 hospitalizations from COVID-19 in the U.S. and between 32,000 and 51,000 deaths. The majority of adults hospitalized last year for COVID had not received the latest vaccine.

Studies suggest that COVID-19 vaccines have saved millions of lives worldwide and have prevented many more hospitalizations. The risk of long COVID, which affects an estimated 400 million people globally, is also significantly reduced with the vaccine, research shows.

“Even people who have had COVID before and have had the vaccine before, if they’re not up to date on their boosters, they are at much higher risk for long COVID following an infection,” Wurtz says.

Your pharmacist should be able to check insurance coverage on the spot, Mehta says, so be sure to bring your insurance card to the pharmacy. If the COVID vaccine is not covered by your plan, he says the adult vaccines can cost about $137 to $142 per dose.

Keep in mind, Mehta says, that “pharmacists can be a really good resource to connect patients to alternatives like a provider’s office, a public health clinic or even help to get manufacturer assistance.”

When should you get the vaccine?

The best time to get the fall COVID vaccine is generally September or October. But if you’ve had a COVID vaccine recently or a COVID infection, you’ll want to wait about three or four months before getting another shot, Talaat says.

“Because you want to maximize the protection you get from each dose. And if you just got a dose a couple of months ago, you’re still quite protected,” she explains.

Concerned about side effects like fatigue, fever and chills? Consider switching brands if you’ve experienced them in the past, Brewer says. “It may be that there are COVID-19 vaccines that will be less reactogenic for those folks,” he says.

Don’t forget about other essential vaccines: In addition to the COVID vaccine, flu shots are recommended in September and October. The RSV vaccine is also recommended for adults 75 and older and people 50-74 with certain health conditions. 

Editor's note: This story has been updated to reflect new information.