The Centers for Disease Control and Prevention on Monday revised its Covid vaccine guidelines, suggesting that individuals aged 65 and above receive Covid vaccinations only after discussing with a healthcare professional like a doctor or pharmacist.

In a press release, the CDC indicated that acting Director Jim O’Neill endorsed the recommendations from an advisory panel last week, resolving a period filled with uncertainty regarding this season’s Covid vaccine. Earlier in the year, Health Secretary Robert F. Kennedy Jr. dismissed all 17 members of the influential vaccine committee, appointing replacements who have previously criticized Covid vaccines.

Kennedy, a prominent anti-vaccine activist who inaccurately labeled the Covid vaccine as the “deadliest vaccine ever made,” initially aimed to restrict vaccine access in May. He bypassed standard regulatory procedures, announcing that the CDC would cease recommending Covid vaccinations for healthy children and pregnant women.

The endorsement by the CDC on Monday does not prohibit individuals younger than 65 from obtaining a Covid vaccine—they still have the option following a consultation with a healthcare provider.

This requirement for “shared clinical decision-making” creates an additional layer in the vaccination process, explained Dr. Yvonne Maldonado, a professor at Stanford University. “It’s essentially advising that your physician, provider, or pharmacist should inform you about the possible risks and benefits before you receive the vaccine.”

According to the CDC, the advisory panel identified the greatest benefit of Covid vaccination for those younger than 65 with increased risk factors for severe Covid due to pre-existing conditions. Meanwhile, the benefit was considered minimal for individuals under 65 who aren’t at an elevated risk for severe Covid.

But how easy it is to get a Covid shot may depend on where you live.

In previous years, states have generally mirrored the CDC’s vaccine guidance, particularly that of the vaccine advisory panel, called the visory Committee on Immunization Practices, ACIP, which had been considered one of the foremost authorities on vaccinations.

Prior to the CDC’s announcement, 26 states (mostly blue states with Democratic governors) had already set their own Covid shot guidance to keep access as broad as possible, according to KFF, a nonpartisan health policy research group.

The result is a complex hodgepodge of Covid vaccine policies nationwide.

“We now have had a breakdown in consensus between the federal government and the states as to how to manage Covid immunization,” said Dr. Ofer Levy, director of the Precision Vaccines Program at Boston Children’s Hospital. “We are facing an unprecedentedly complicated landscape.”

Illinois, Maryland and Washington, D.C., for example, officially recommend universal Covid vaccination for everyone 6 months and older. Other states, like California, Michigan and Minnesota, recommend the shots for everyone 3 years and older.

“Viruses don’t respect state borders,” Levy said. “From the perspective of protecting the public against infectious diseases, the last thing you would want as a strategy is to protect different states differently. It’s confusing, it’s inconsistent, and it leaves certain people vulnerable.”

What’s more, some doctors’ offices might not have any incentive to stock the vaccine since the CDC’s recommendation focuses on older adults. Last season, 23% of adults and 13% of children got the Covid vaccine, according to the CDC.

“There’s all kinds of ways where people who want the vaccine might not be able to get it because of all of these little obstacles that are put in place, even though, in theory, anybody 6 months and older should be able to get them,” said Maldonado, who is also a pediatrician.

In a statement, Amy Thibault, a spokesperson for CVS Health, said its pharmacies would be ready to administer Covid shots for people ages 5 and older as soon as the CDC signed off.

Walgreens starts Covid vaccines at age 3. A spokesperson for Walgreens said in an email that the pharmacy chain “will offer the 2025-2026 COVID-19 vaccines at locations nationwide” without a prescription.

Do I need a Covid shot?

While a summer uptick in cases appears to have peaked in most areas of the country, according to CDC surveillance, every year since the Covid pandemic started in 2020 has also had a winter wave.

Like the flu shot, the Covid vaccine doesn’t necessarily stop a person from getting infected with the virus. But it does reduce the chances of severe illness, hospitalization or death.

Pfizer and Moderna’s updated Covid shots target the LP.8.1 variant, which was the dominant strain in the U.S. earlier this year but has been overtaken by newer variants. Novavax’s updated Covid shot targets an even older strain, called JN.1.

As of Sept. 27, LP.8.1 accounts for just 3% of all new Covid cases, according to the CDC. A strain called XFG is now dominant, accounting for at least 85% of new Covid cases. All are descendants of the omicron variant, which emerged in late 2021.

Research presented by Moderna and Pfizer at an FDA advisory committee meeting in May found that the updated shot generated a modestly stronger immune response to the strains circulating at that time than last year’s Covid shots.

It typically takes a few weeks after the Covid vaccine for immunity to build.

Is the Covid shot free?

Most people with insurance who want a Covid vaccine should be able to get it free this year.

Ahead of the CDC’s advisory committee meeting, AHIP, a health insurance industry trade group, said that private plans will continue to cover all CDC-recommended vaccines that were recommended as of Sept. 1, meaning its previous Covid shot recommendation for everyone 6 months and older still applies.

Medicare, Medicaid and other government health programs will continue to cover the shots at no cost, according to an HHS spokesperson.