What vaccinations are covered for a 65-year-old male on Medicare, considering his age and potential chronic medical conditions?

Medicare-Covered Vaccinations for a 65-Year-Old Male

All 65-year-old males on Medicare should receive annual influenza vaccination (preferably high-dose), pneumococcal vaccination (single dose of PCV20 preferred, or PCV15 followed by PPSV23), recombinant zoster vaccine (2-dose series), and Tdap/Td boosters every 10 years. 1, 2, 3

Core Vaccinations Covered by Medicare Part B

Influenza Vaccination

• Annual influenza vaccination is mandatory for all adults aged ≥65 years 2, 3
• High-dose influenza vaccine is preferred over standard-dose formulations due to increased immunogenicity in older adults 2, 3
• Medicare Part B covers this annually without cost-sharing 1

Pneumococcal Vaccination

The CDC now recommends a single dose of PCV20 as the preferred option for adults aged ≥65 years 2, 4, 3

Alternative approach if PCV20 is unavailable:

• Administer PCV15 followed by PPSV23 at least 1 year later 2, 4, 3
• If using the older PCV13/PPSV23 sequence, PCV13 must be given first, with PPSV23 administered at least 1 year apart 1, 3
• Never administer both vaccines during the same visit 1, 3

Medicare Part B covers both pneumococcal vaccines without cost-sharing 1

Zoster (Shingles) Vaccination

• Recombinant zoster vaccine (RZV/Shingrix) is strongly recommended for all adults aged ≥50 years 1, 3
• Administer as a 2-dose series, 2-6 months apart (minimum interval: 4 weeks) 1, 3
• RZV is preferred over the older live zoster vaccine (ZVL/Zostavax) 1, 3
• Give RZV regardless of prior herpes zoster history or previous ZVL vaccination 1
• Medicare Part D (not Part B) covers this vaccine, so cost-sharing may apply depending on the plan 1

Tetanus-Diphtheria-Pertussis (Tdap/Td)

• One dose of Tdap, then Td or Tdap booster every 10 years 1, 3
• Medicare Part B covers this 1

Additional Vaccines Based on Risk Factors

For Chronic Medical Conditions

If the patient has chronic heart disease (excluding hypertension alone), chronic lung disease, diabetes, chronic liver disease, or is a current smoker:

• PPSV23 is indicated even before age 65 1
• At age 65, if already received PPSV23, administer another dose at least 5 years after the previous PPSV23 (only 1 dose recommended at age ≥65) 1

For Immunocompromising Conditions

If the patient has chronic renal failure, nephrotic syndrome, functional/anatomic asplenia, cerebrospinal fluid leak, cochlear implant, HIV infection, leukemia, lymphoma, solid organ transplant, or is on immunosuppressive therapy:

• Administer PCV20 as preferred option, or PCV15 followed by PPSV23 at least 8 weeks later 3
• Then administer another dose of PPSV23 at least 5 years after the previous PPSV23 1
• At age ≥65, administer one final dose of PPSV23 at least 5 years after the most recent PPSV23 1

Hepatitis A Vaccination

Indicated for:

• Men who have sex with men 1, 3
• Injection or non-injection illicit drug users 1, 3
• Chronic liver disease 1, 3
• Travel to endemic areas 1, 3
• Administer 2-dose series at 0 and 6-12 months (Havrix) or 0 and 6-18 months (Vaqta) 1

Hepatitis B Vaccination

• Not routinely recommended at age 65 unless specific risk factors present 1
• Medicare Part B covers this for high-risk individuals 1

Important Clinical Pitfalls

Common sequencing error: Administering PPSV23 before PCV13/PCV15/PCV20 negates the benefit of the conjugate vaccine 1, 3. Always give the conjugate vaccine first.

Timing error: Administering PCV13 and PPSV23 at the same visit reduces immunogenicity 1, 3. The minimum interval is 1 year for routine vaccination in immunocompetent adults aged ≥65 years 1.

Coverage confusion: Zoster vaccine (Shingrix) is covered under Medicare Part D (prescription drug plan), not Part B, so patients may have out-of-pocket costs depending on their specific plan 1. Influenza and pneumococcal vaccines are covered under Part B with no cost-sharing 1.

Updated recommendations: The 2020 guidelines recommended PCV13 based on "shared clinical decision-making" for immunocompetent adults aged ≥65 years 1, but newer 2025 guidelines now recommend PCV20 as the preferred single-dose option, simplifying the regimen 2, 4, 3.