Abstract Background Research reveals that influenza and pneumococcal immunization rates among blacks, Asians, and Hispanics significantly trail those of whites. This 2003 study examines recent trends and disparities for influenza and pneumococcal immunizations among elderly, non-institutionalized Medicare beneficiaries. Methods National samples of approximately 179,000 Medicare fee-for-service beneficiaries were surveyed by mail and telephone each year from 2000 to 2002. Outcomes include self-reported influenza immunization in the previous year and receipt of a pneumococcal immunization ever. Results Influenza immunization dipped in 2001 (69%) and almost rebounded to its 2000 level (73%) in 2002 (72%). Very substantial racial and ethnic disparities in the receipt of this preventive service exist between non-Hispanic blacks and Hispanics relative to non-Hispanic whites. Pneumococcal immunization increased by 2% annually (61%, 63%, and 65%) for the same years. However, very substantial racial and ethnic disparities in the receipt of this preventive service also exist between non-Hispanic blacks, Asians/Pacific Islanders, and Hispanics relative to non-Hispanic whites. Conclusions Younger, healthier, elderly persons must be encouraged to receive these immunizations to achieve the 2010 goal of 90% immunization. To reach that goal with no disparities, special efforts will be needed to target racial/ethnic minorities.