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.

What medications will no longer be covered by Medicare?

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.)

What 10 drugs will be reduced by Medicare?

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. 

What is the best secondary insurance to have with Medicare?

The "best" secondary insurance for Medicare depends on your needs, but Medicare Supplement (Medigap) plans are most common, with Plan G often recommended for new enrollees (after the Part B deductible) for comprehensive coverage, and Plan N as a more affordable alternative with small copays. Top providers known for Medigap include AARP/UnitedHealthcare, Mutual of Omaha, Aetna, Humana, and Blue Cross Blue Shield, offering reliability, wide networks, or extra perks.
 

What will Medicare prescription drug coverage be in 2026?

If you have Medicare drug coverage (Part D), your yearly out-of-pocket Part D drugs will be capped at $2,100 in 2026. Once you reach this cap, you won't have to pay a copayment or coinsurance for covered Part D drugs for the rest of the calendar year (page 83).

Medicare, Medicaid decline to cover popular weight loss drugs for obesity

What are the biggest mistakes people make with Medicare?

Here are some of the biggest Medicare mistakes to avoid:

• Missing the initial enrollment window. ...
• Assuming Medicare covers everything. ...
• Overlooking the benefits of supplemental coverage. ...
• Forgetting to enroll or re-evaluate prescription drug coverage. ...
• Not comparing plans regularly.

What blood tests does Medicare not cover for seniors?

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.

What is the most expensive drug for Medicare?

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.

Is Medicare changing in 2025 for seniors?

In 2025, major Medicare changes focus on prescription drugs (Part D), including a new $2,000 annual out-of-pocket cap, elimination of the "donut hole," a new monthly payment option for drug costs, and lower prices for some popular drugs due to negotiations, alongside typical yearly Part B premium/deductible increases and expanded mental health provider access. These updates aim to reduce drug costs and simplify coverage for seniors.

What can I do if my prescription is too expensive?

If your prescription is too expensive, talk to your doctor and pharmacist about cheaper alternatives (generics or different drugs), use discount cards like GoodRx or manufacturer coupons, check for patient assistance programs, compare prices at different pharmacies, and explore mail-order options for 90-day supplies.

What Medicare service is ending in 2026?

Major PPO Medicare Advantage carriers are exiting California for 2026. UnitedHealthcare, Blue Shield, and Anthem Blue Cross are discontinuing their PPO Advantage plans statewide, leaving hundreds of thousands of California seniors needing to transition to a new plan before the December 7th Medicare deadline.

Who qualifies for an extra $144 added to their Social Security?

The extra $144 added to a Social Security check usually comes from the Medicare Part B Giveback Benefit, a rebate from certain Medicare Advantage (Part C) plans that reduces your Part B premium, appearing as extra money on your check if premiums are deducted from Social Security. To qualify, you must be enrolled in Medicare Parts A & B, pay your own Part B premium (not through Medicaid), live in the plan's service area, and be enrolled in a Medicare Advantage plan offering this specific benefit, with the amount varying by plan and location.

What are the six high risk medications?

High risk medications

• A – Antimicrobials.
• P – Potassium and other electrolytes, psychotropic medications.
• I – Insulin.
• N – Narcotics, opioids and sedatives.
• C – Chemotherapeutic agents.
• H – Heparin and other anticoagulants.
• S – Safer systems (e.g. safe administration of liquid medications using oral syringes)

How many times a year will Medicare pay for a lipid panel?

For asymptomatic patients without cardiovascular disease, Medicare covers lipid panels once every five years. However, for individuals who are on long-term anti-lipid therapy or have borderline high cholesterol, annual testing may be warranted and covered, reflecting the need for ongoing monitoring in these cases.

Which medicare plan covers dental vision and hearing?

Medicare Advantage (Part C) plans can offer coverage for dental and vision health items in addition to also offering the same coverage as Original Medicare. Most also include prescription drug coverage as well as other benefits such as hearing health coverage and gym memberships.

What states have the worst Medicare?

Vermont, Utah and Minnesota topped the Commonwealth Fund's Medicare performance scorecard in 2025, whereas Kentucky, Mississippi and Louisiana struggled the most.

Why are doctors dropping Medicare?

Some doctors don't accept Medicare primarily due to lower reimbursement rates compared to private insurance, high administrative burdens (paperwork, rules, audits), and the rising costs of running a practice, making it less financially viable; opting out allows them more control over fees and less red tape, though it shifts the full cost to the patient.

What is the best Medicare drug plan?

The "best" Medicare drug plan (Part D) depends on your specific medications and budget, but top-rated providers for 2026 often include UnitedHealthcare, Humana, Aetna, and Cigna, known for different strengths like low deductibles, $0 premium options, or strong quality ratings. Key factors to compare are your drugs' formulary coverage, monthly premiums, deductibles, copays, and pharmacy networks, using tools like the Medicare Plan Finder to find the most affordable and comprehensive choice for you.
 

Will Jardiance be generic in 2025?

While generic empagliflozin availability remains uncertain until at least 2025, current cost-saving strategies can make this important diabetes medication more affordable today.

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