WASHINGTON, D.C.: Getting a COVID-19 shot this year may not be as straightforward as before. A mix of new federal guidance, insurance uncertainties, and limits on where the vaccines can be given has complicated what used to be a simple seasonal step for millions of Americans.

The U.S. Food and Drug Administration recently cleared new vaccines from Pfizer, Moderna, and Novavax, but the approvals came with narrower eligibility than in the past. Shots are now authorized for people 65 and older, as well as for younger adults with health conditions that increase their risk of severe illness — including asthma, cancer, obesity, heart and lung disease, depression, or a history of smoking.

That shift creates uncertainty about how pharmacies and insurers will handle vaccinations. "A high proportion of people would qualify for these vaccines even if they're not over 65," said Dr. Paul Sax of Brigham and Women's Hospital.

Previously, the U.S. Centers for Disease Control and Prevention, guided by an expert committee, recommended yearly COVID-19 vaccines for everyone six months and older. However, earlier this year, Health Secretary Robert F. Kennedy Jr. dismissed that committee, and replacements have yet to issue new recommendations.

Access is another hurdle. Most Americans rely on pharmacies for COVID-19 vaccines. Yet, in 19 states, pharmacists are limited to giving vaccines backed by the CDC advisory committee. Without its recommendation, some pharmacies may not be able — or willing — to provide the shots.

Insurance coverage also remains unsettled. Medicare will cover the vaccines for those 65 and older, but coverage for younger groups is less clear. Some insurers and employers, like Walmart and Kaiser Permanente, say they will continue covering the shots. Others are waiting on policy guidance. Without coverage, doses can cost US$150 or more.

Experts note that insurers still have an incentive to pay, since vaccines help avoid costly hospitalizations and keep workers healthy. "They can save money by preventing expensive medical care," said Beth Umland of Mercer.

Conflicting official advice has fueled patient confusion. Kennedy announced in May that vaccines would no longer be recommended for healthy children and pregnant women, a move contradicted by groups like the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics.