Medicare generally does not cover weight-loss drugs (e.g., Wegovy, Zepbound), erectile dysfunction medications (e.g., Viagra, Cialis), cosmetic/hair growth products (e.g., Propecia), fertility drugs, or over-the-counter medications. While GLP-1 drugs like Ozempic are covered for Type 2 diabetes, they are excluded when used solely for weight loss.
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.
Medicare Part D generally excludes drugs for weight loss/gain, cosmetic purposes (like hair growth), fertility, and most cough/cold relief, plus non-prescription (OTC) meds and most vitamins (except prenatal/fluoride). Specific examples include Viagra (for ED), Propecia (hair loss), Xenical (weight loss), and Robitussin AC. Coverage varies by plan, but these categories are national guidelines.
Here are the top reasons why:
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.
Yes, the Medicare Part D donut hole (coverage gap) is officially eliminated as of January 1, 2025, thanks to the Inflation Reduction Act, simplifying the benefit into three phases: deductible, initial coverage, and catastrophic coverage, with a new $2,000 out-of-pocket maximum for drug costs in 2025.
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:
In 2025, there are still many healthcare costs that Medicare won't cover — from dental work and vision needs to hearing aids, overseas medical care, and, perhaps most significantly, long-term custodial care. But the good news is that you don't have to face these gaps unprepared.
There are some things Original Medicare won't cover. Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Other services not covered by Medicare Parts A and B include: Routine physical exams.
Starting this year, all Medicare beneficiaries with Part D drug coverage have a $2,000 annual cap on their out-of-pocket medication costs. The cap, part of the 2022 Inflation Reduction Act, is meant to protect Medicare recipients who are not eligible for low-income subsidies from high drug costs.
High risk medications
Yes, the Biden administration, through the Inflation Reduction Act (IRA) signed in 2022, eliminated the Medicare Part D "donut hole" (coverage gap) as of January 1, 2025, replacing it with a simpler structure that includes a $2,000 out-of-pocket cap on drug costs for the year, after which beneficiaries pay nothing for covered drugs. This change means beneficiaries now move directly from initial coverage to catastrophic coverage, simplifying costs and providing significant financial relief.
The Medicare 2-Midnight Rule is a Centers for Medicare & Medicaid Services(CMS) guideline for hospital admissions, stating that if a doctor expects a patient to need hospital care crossing at least two midnights, the stay generally qualifies for Medicare Part A inpatient payment;
Beginning January 1, 2026, multivitamin combination products will no longer be covered. Single-ingredient vitamins and dry-eye treatments will require prior authorization to demonstrate medical necessity, while coverage of first- and second-generation antihistamines will be restricted to generic formulations.
You can still use GoodRx even if you're enrolled in Medicare. GoodRx discounts are separate from your insurance, so you can choose whichever price is lower. You just can't combine a GoodRx discount with your Part D benefits for the same prescription.