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.
Medicare does not cover:
Medicare's first round of drug price negotiations under the Inflation Reduction Act (IRA) targets 10 high-cost drugs for price reductions starting in 2026, including Eliquis, Enbrel, Entresto, Farxiga, Fiasp/NovoLog (insulin), Imbruvica, Januvia, Jardiance, Stelara, and Xarelto, affecting conditions like blood clots, diabetes, cancer, and heart failure, with average out-of-pocket cost declines expected around 50% for beneficiaries.
Starting in 2025, there is an annual limit on what you pay out-of-pocket for prescription medications through Medicare and Medicare Advantage prescription drug plans. All prescription medications, including specialty medications, covered by Part D plans are included under this cap.
For 2026, Medicare Part D plans feature a significant change with a new $2,100 out-of-pocket (OOP) cap for prescription drugs, meaning after you spend that amount, your plan pays 100% for covered meds for the rest of the year, plus lower average premiums (around $34.50) and insulin costs capped at $35 monthly. Key shifts include a maximum deductible of $615 and automatic enrollment/renewal for the Medicare Prescription Payment Plan (MPPP). Enrollees should compare plans during Open Enrollment (Oct 15–Dec 7) to find the best fit for their specific medications and pharmacies.
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.
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 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.
Here are some of the biggest Medicare mistakes to avoid:
The 10 drugs with negotiated lower prices for 2026:
High risk medications
If you joined a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without a drug plan) within the first 3 months you have Medicare Part A & Part B.
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).
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.
Drugs for anorexia, weight loss, or weight gain (i.e., Xenical®, Meridia, phentermine HCl, etc.) 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.)