Medicare Part D doesn't cover certain drug classes by law, including weight loss/gain meds (unless for other conditions like diabetes/heart), fertility drugs, hair growth/cosmetic drugs, cough/cold relief meds (unless for other specific uses), ED drugs (unless for other conditions), and most vitamins/minerals (except prenatal/fluoride). While some anti-obesity drugs (GLP-1s) were proposed for coverage, the Trump Administration decided against it for 2026, though they remain covered for diabetes/heart conditions, with potential future review for obesity.
Drugs that promote fertility (i.e., Clomid, Gonal-f, Ovidrel®, Follistim®, etc.) Drugs for cosmetic purposes or hair growth (i.e., Propecia®, Renova®, Vaniqa®, etc.) Drugs for the relief of cough and cold symptoms (i.e., Phenergan w/Codeine, Robitussin® AC, Tanafed, Tessalon® Perle, etc.)
Eliquis (generic name: Apixaban) alone racked up $18.3 billion in Medicare spending in 2023, nearly double the next drug, Ozempic. Alongside Xarelto, anticoagulants accounted for over $24 billion in 2023.
The $2,000 prescription cap for seniors is a real benefit from the Inflation Reduction Act (IRA) that began in 2025, setting a limit on out-of-pocket prescription drug costs for Medicare Part D enrollees, meaning beneficiaries pay no more than $2,000 annually for covered medications, with the cap increasing to $2,100 in 2026. This major change eliminates the "donut hole" and provides significant savings for seniors with high drug costs, allowing costs to be spread out monthly.
The most prescribed drug in the U.S. is consistently Atorvastatin (Lipitor), a statin for lowering cholesterol, though rankings shift slightly by year with drugs like Levothyroxine (thyroid) and Metformin (diabetes) also in the top ranks. Amoxicillin, an antibiotic, is another very common prescription, while blood pressure medications (like Lisinopril) frequently appear in the top lists due to high prevalence of hypertension.
Here are some of the biggest Medicare mistakes to avoid:
It's important to know that Medicare won't cover any blood test if it isn't medically necessary. If you seek a blood test on your own, it's unlikely you'll get it covered. Tests not covered may include those for employment purposes, wellness screenings, or routine monitoring without medical necessity.
No single Medicare plan pays 100% of everything, but Medigap Plan F (for those eligible before 2020) and Medigap Plan G (most newer enrollees) cover nearly all gaps in Original Medicare after the Part B deductible, paying 100% of approved costs, while Medicare Advantage (Part C) plans have an out-of-pocket maximum, after which they pay 100% of covered services. Other Medigap plans like K, L, or N offer lower premiums in exchange for sharing some costs until an annual limit is met, after which they cover 100%.
People leave Medicare Advantage (MA) plans due to difficulty accessing needed care (especially with worsening health), restrictive provider networks, complex prior authorization rules, and dissatisfaction with care quality, often feeling trapped as their health needs grow despite initial low costs and extra perks that become limiting. Issues with provider availability, network changes, and sometimes misleading marketing also drive disenrollment, pushing people back to Traditional Medicare for greater freedom, notes KFF.
While your Medicare Part D gives you main prescription coverage, GoodRx can help you save even more money. Sometimes, the savings can be more than what you pay in copayments or coinsurance.
The extra $144 added to Social Security usually comes from the Medicare Part B Giveback benefit, offered by some Medicare Advantage (Part C) plans, which pays back some or all your Part B premium, showing up as extra money in your check if it's deducted from your Social Security. To qualify, you need Original Medicare (Parts A & B), pay your own Part B premium, live in a plan's service area, and enroll in a specific Medicare Advantage plan that offers this "rebate," with the amount varying by plan and location.
The Medicare "3-Day Rule" requires a beneficiary to have a qualifying 3-day inpatient hospital stay (admission day counts, discharge day doesn't) before Medicare will cover services in a Skilled Nursing Facility (SNF) for rehabilitation or skilled care, though this rule can be waived in certain Medicare Advantage plans or through specific Accountable Care Organization (ACO) initiatives. Time spent in observation or the Emergency Department doesn't count towards these 3 days, but new demonstration projects and waivers are emerging to offer more flexibility for patients needing SNF care.
Vermont, Utah and Minnesota topped the Commonwealth Fund's Medicare performance scorecard in 2025, whereas Kentucky, Mississippi and Louisiana struggled the most.
The "best" secondary insurance for Medicare depends on your needs, but Medigap Plan G and Plan N are top choices for most new enrollees, offering comprehensive coverage for costs Original Medicare doesn't cover, with Plan G covering nearly everything (except the Part B deductible) and Plan N being more affordable with small copays. Top providers known for Medigap include UnitedHealthcare (AARP), Aetna, Humana, and Mutual of Omaha, offering nationwide networks and strong customer satisfaction.
Less freedom in choosing health care providers.
In some areas, it can be difficult to find a local doctor or hospital that works with Medicare Advantage. And if you visit a doctor or a hospital that isn't “in-network,” you will pay higher out-of-pocket costs.
The "best" Medicare plan for seniors depends on individual needs, but top-rated providers for Medicare Advantage (Part C) in 2026 include Humana, UnitedHealthcare, Aetna, and Blue Cross Blue Shield (BCBS), offering nationwide coverage, large networks, $0 premium options, and extra benefits like dental/vision, while Medigap (Medicare Supplement) plans like Plan F provide comprehensive Original Medicare cost coverage. Key factors are your doctors, prescriptions, budget, and preference for network flexibility (MA) or broad coverage (Medigap).
Our study shows that antibiotics top the list of drugs most overprescribed in the U.S. In 2022, U.S. healthcare providers issued 236. 4 million antibiotic prescriptions. This works out at 7 prescriptions per 10 people in an outpatient (non-hospital) medical setting.