Getting a Grip on Medicare Options
Healthcare experts agree there’s an awareness problem with Medicare and that not understanding the program’s full value is doing themselves a disservice.“The average American is not getting everything available through Medicare,” Dr. Mike Daniels, chief medical officer at WeTreatFeet Podiatry, told NTD News.
Daniels said he sees patients who’ve carried the same coverage for years but who have never used benefits that could improve their health or lower their expenses.
“Medicare provides a great deal of information, but that doesn’t mean the benefits are easy to find, understand, and use,” he noted. “Patients receive thick handbooks, plan notices, and explanation-of-benefit statements, yet most patients think this is filled with unfamiliar language, useless information, or confusion.”
The situation grows even more confusing because Original Medicare, Medicare Advantage and Part D plans have different rules. “Medicare Advantage benefits can also vary by plan, location, provider network and year,” Daniels added.
1. Preventive Healthcare Programs Top the List
One of Daniels’ favorite underused benefits is preventive care. “Medicare covers a long list of screenings and preventive services, and patients generally pay nothing for most of them,” he said. One especially helpful Medicare prevention program Daniels encourages patients to use is the Medicare Annual Wellness Visit, primarily because it’s different from a routine physical.“The wellness visit gives the patient and provider an opportunity to review health risks, vaccines, and overdue screenings,” Daniels noted.
Additionally, many older adults don’t regularly see a geriatrician, and the wellness visit changes that equation.
“The visit gives a Medicare user’s clinician structured time to step back from immediate medical concerns, assess their overall health and risks, review medications and cognitive health, and develop a personalized prevention plan,” Dr. Dennis Weaver, MD and chief clinical officer at Pearl Health, told NTD.
2. Out-of-pocket protection
Price-wise, another important benefit many users don’t know about is the Medicare Part D out-of-pocket protection. In 2026, a patient’s spending on covered Part D medications is capped at $2,100 for the year, and the voluntary Medicare Prescription Payment Plan can also spread medication expenses over the calendar year, although it doesn’t reduce the total cost.3. Vision programs for Medicare users
Other medical experts say Medicare patients aren’t getting enough from their Medicare coverage when it comes to their eyes.“Vision care is a huge gap that is missing from Medicare,” Dr. Christina Herald, an optometrist and a private practice owner at Massachusetts-based Fall River Vision. “Medicare makes a distinction between 'routine vision' and medical services.”
Yet there are a few hidden hacks when it comes to eye benefits and Medicare. For instance, if a patient has a medical condition such as diabetes, cataracts, or glaucoma, they can get their eyes checked for their medical condition, and then they can pay out-of-pocket for things like routine retinal imaging and the glasses check portion. “This saves them from having to pay for the entire visit component themselves,” Herald said.
Getting More Out of Medicare, One Action Step at a Time
To launch your overall Medicare knowledge journey, go to the source and leverage the program’s growing number of program’s articles, videos, and updates“A good starting point is a secure Medicare.gov account, combined with Medicare’s email updates and the annual 'Medicare & You' handbook,” Weaver said.
Because coverage decisions are personal, beneficiaries should also discuss relevant changes with a trusted healthcare provider or benefits advisor and contact their local State Health Insurance Assistance Program, or SHIP, for free, independent healthcare counseling. “That’s particularly the case before changing plans or coverage,” Weaver said.