9 Things Medicare Is Not Allowed to Do in 2026
Medicare is not allowed to cover 9 things. Not will not. Not allowed. And number one on that list is your Medicare Part B premium, $2,435 a year out of your Social Security check.
My 82-year-old dad Wallace is a Vietnam-era veteran. He found the one thing Medicare’s own handbook admits is allowed to help.
By the end of this article, you will know the 9 things Original Medicare is not allowed to do, why a rulebook written in 1965 still decides what you pay today, and what Medicare Part C is allowed to do about it.
Why Does Original Medicare Say No to So Much?
Here is what nobody tells you about Original Medicare. When Part A and Part B do not cover something, it is not because Medicare decided to say no. It is because the law says Medicare is not allowed to say yes.
These rules were written in 1965. Most of you were kids. Congress wrote the rulebook, locked the doors, and never came back.
Sixty years of veterans have retired into a rulebook never written with veterans in mind. So every item on this list is not a gap. It is a rule written down sixty years ago.
Let us count them down. Smallest to biggest.
Does Original Medicare Cover a Gym Membership or Over-the-Counter Items?
Number nine. A gym membership. Medicare is not allowed to pay for one. It does not matter what your doctor says about staying active. Not allowed.
Number eight. An over-the-counter allowance. The aspirin. The vitamins. The cold medicine you buy at the pharmacy without a prescription. Part A and Part B are not allowed to give you one dollar toward any of it. Not allowed.
Small items. I know. They get bigger from here.
I am Chris Duncan, and I have been helping retirees with Medicare and retirement planning for nearly 20 years. Our organization focuses on veterans. This is the list we walk through on almost every call, because almost nobody has ever seen these rules laid out in one place.
Does Original Medicare Cover Hearing Aids, Glasses, or Dental?
Number seven. Hearing. Routine hearing exams. Hearing aids. Part A and Part B are not allowed to cover them. Think about it. Hearing aids run thousands of dollars a pair, and the program you paid into your whole life is forbidden from touching the bill. Not allowed.
Number six. Vision. Routine eye exams. Eyeglasses. Contact lenses. Not allowed.
Number five. Dental. The big one hitting almost every veteran over 65. Routine cleanings. Fillings. Dentures. Part A and Part B are not allowed to cover routine dental. Not allowed.
Hearing. Vision. Dental. The three things your body needs most after 65. Medicare is not allowed to cover any of the three.
Does Original Medicare Cover Prescriptions?
Number four. Your prescriptions. The medications you pick up at the pharmacy. Medicare is not allowed to cover most of them.
Medicare Part D exists as a separate program for exactly this reason. The original rulebook forbids it. Not allowed.
Does Medicare Cover You Outside the United States?
Number three. Coverage outside the United States. This one surprises everybody.
In most situations, if you get sick or hurt in another country, Medicare is not allowed to pay. You take a cruise. You visit family overseas. You cross a border. In most cases, Medicare stays home. Not allowed.
Does Original Medicare Have an Out-of-Pocket Maximum?
Number two. A yearly limit on what you pay out of pocket. Now we are in the serious money.
Page 11 of the 2026 Medicare and You handbook says it plainly. With Original Medicare, there is no yearly limit on what you pay out of pocket unless you have supplemental coverage.
Read it again. No limit. A bad year with deductibles and 20 percent coinsurance, and there is no ceiling. No number where Medicare steps in and says you have paid enough.
Medicare is not allowed to protect you with a cap. Not allowed.
Why Is the Medicare Part B Premium $202.90 a Month?
Number one. Your Part B premium. The one costing veterans more than all the others combined.
$202.90 a month in 2026. $2,435 a year. Straight out of your Social Security check. And nothing inside Part A or Part B is allowed to help you pay it.
Now, if your income is low enough, your state has help for that premium. That is real and it is worth checking. But look at where the help comes from. It comes from Medicaid, a completely different program. Even the government’s own premium help had to go around the rulebook.
Nothing inside Part A or Part B is allowed to touch that bill. Medicare is not allowed to help you with your own Medicare premium.
You pay it every month. And that is if the premium never goes up. The premium goes up almost every year. Over 20 years at today’s rate, that is roughly $48,700. The rulebook says Part A and Part B are not allowed to help with any of it.
What Are the 9 Things Medicare Is Not Allowed to Do?
| # | What Original Medicare is not allowed to cover | The reason |
|---|---|---|
| 9 | Gym membership | Not in the 1965 rulebook |
| 8 | Over-the-counter allowance | Not in the 1965 rulebook |
| 7 | Routine hearing exams and hearing aids | Not in the 1965 rulebook |
| 6 | Routine eye exams, eyeglasses, contact lenses | Not in the 1965 rulebook |
| 5 | Routine dental, cleanings, fillings, dentures | Not in the 1965 rulebook |
| 4 | Most prescription drugs | Part D exists as a separate program |
| 3 | Care outside the United States, in most cases | Not in the 1965 rulebook |
| 2 | A yearly out-of-pocket maximum | Page 11 confirms there is no yearly limit |
| 1 | Any help with your $202.90 Part B premium | Roughly $48,700 over 20 years |
Nine rules. Sixty years old. All of them forbidding.
What Changed in 1997? Medicare Part C
So here is the question. If Congress locked those doors in 1965, and Medicare is not allowed to reopen them, did anybody ever build another door?
They did. In 1997, Congress wrote a new set of rules. Medicare Part C.
Medicare Advantage, also called Part C, plays by a different rulebook. Part C is allowed to provide benefits going beyond what Original Medicare provides on its own. And Medicare rules allow Part C plans to have a monthly premium as low as $0.
Now hold on. $0 does not mean free. Nothing about Medicare is free. You already paid for it.
FICA came out of every paycheck you ever earned. Military service. Civilian jobs. It did not matter. And your federal income taxes paid in on top of that, year after year. A $0 premium is not a handout. It is what you already bought, finally showing up.
Do You Need Medicare Part A and Part B to Enroll in Part C?
Yes. To be eligible for Part C, you must have Medicare Part A and Part B. You cannot skip Part B and enroll in Part C. Part A and Part B are the foundation.
Does a Part C Plan Change Your VA Health Benefits?
No. Part C plans are not allowed to change your VA health benefits in any way. Your VA benefits stay exactly the same.
What Do the VA and Original Medicare Not Cover?
Does the VA cover routine dental? Unless you have a 100% rating, no. Vision? Sometimes. Hearing? Sometimes. And most veterans do not have a 100% rating.
Original Medicare does not cover routine dental. Does not cover vision. Does not cover hearing.
What about a gym membership? An over-the-counter allowance? Neither one provides those.
Medicare Advantage, also called Part C, is allowed to provide benefits going beyond what the VA and Original Medicare provide on their own. Benefits and costs vary by county and plan.
What Does Page 11 of the Medicare Handbook Say About Your Part B Premium?
Now back to number one on that list. Your Part B premium.
Even that one has a door. On Page 11 of the 2026 Medicare and You handbook, the same page admitting there is no yearly out-of-pocket limit, Medicare says this about Medicare Part C plans: “Some plans may have a $0 premium and may help pay all or part of your Part B premium.”
That is Medicare’s own handbook. The thing Medicare is not allowed to do on its own, Medicare’s own pages say some plans may do.
$0 premium. Medicare rules allow Part C plans to have a monthly premium as low as $0. Options exist for your Part B premium. Benefits and costs vary by county and plan.
How Much Does My Dad Pay for Medicare Part B?
Let me show you what it looks like in real life.
My dad Wallace. 82 years old. Vietnam-era veteran. He uses the VA and we are happy with the care the VA gives him.
Last year Dad called me. “Chris, they will not cover it.” He needed a procedure. The VA said the procedure was not medically necessary. Denied. 82 years old, and the system he served said no.
But Dad had a Part C plan. His plan covered the procedure. No arguments. No appeals. No stress. No waiting.
Dad’s VA benefits did not change. VA benefits cannot be changed by Medicare Advantage.
Dad said it best. “Chris, the VA is great, but it ain’t perfect.”
Remember, Medicare is not allowed to help Dad with his Part B premium. His Part C plan is. And here is Dad’s Part B situation. Dad’s Part C plan costs $0 a month. Dad is not receiving any low-income subsidies. And because of what Page 11 describes, Dad gets $185 of his $202.90 Part B premium covered.
Our average client gets $145 of their Part B premium covered. Some get more. Some get less.
Now the disclaimer, and I mean every word of it. Dad’s $185 is the highest available in his county. That does not mean $185 is available in your county. It does not mean this option is available in your county at all. Some counties have plans with this option. Some counties do not. Every county is different. Every plan is different. The amount is different. Benefits and costs vary by county and plan.
What Happens If You Skip Medicare Part B?
One warning before the finish. None of this works if you skip Part B.
Skip Part B and the Medicare Part B late enrollment penalty is 10 percent for every full 12 months you delay. That penalty is permanent. For life.
And it is a double whammy. The premium goes up. The penalty goes up with it. The rulebook punishes waiting forever.
Three Veterans, Same Part B Premium, Three Different Outcomes
Three veterans. Same age. Same Part B premium. Three different outcomes.
Veteran One listened to bad advice. He skipped Part B for five years. Now he pays a 50 percent penalty every month, for life. And that is if the premium never goes up.
Veteran Two enrolled in Medicare but never learned what you learned here. He pays the full $202.90 every month. He covers every item Medicare is not allowed to cover out of his own pocket. No cap protecting him.
Veteran Three knows what Dad knows. He enrolled on time. He looked at what Part C is allowed to do in his county. Medicare Advantage working harder for him. And his VA benefits did not change.
Same age. Same Part B premium. Three completely different outcomes.
Which veteran are you going to be?
What Should You Do Next?
Nine things Medicare is not allowed to do. One rulebook from 1965. And one sentence changing the whole game.
If you are approaching 65, you have a 7-month window around your birthday to enroll without penalties. Three months before, your birthday month, and three months after. Miss that window and the penalty follows you for life. There is no reset button.
Look at what Part C is allowed to do in your county. That number is different everywhere, which is why we look it up for every veteran individually.
If your income crossed a threshold, your Part B premium may already be higher than $202.90. See how IRMAA raises your Part B premium and run the numbers with our IRMAA calculator.
2026 Medicare Part B and Part C Quick Reference
Here are the numbers behind the 9 things Medicare is not allowed to do.
| Item | 2026 Amount |
|---|---|
| Standard Medicare Part B premium | $202.90 per month |
| Annual standard Part B cost | About $2,435 |
| 20-year Part B cost at today’s rate | Roughly $48,700 |
| Original Medicare yearly out-of-pocket limit | None |
| Original Medicare coinsurance | 20 percent |
| Year the Original Medicare rulebook was written | 1965 |
| Year Congress created Medicare Part C | 1997 |
| Medicare Part C premium allowed under Medicare rules | As low as $0 per month |
| Required before enrolling in Part C | Medicare Part A and Part B |
| Dad’s Part B premium | $17.90 per month |
| Dad’s Part B amount covered | $185 per month |
| Average client Part B amount covered | $145 per month |
| Part B late enrollment penalty | 10 percent for every full 12 months delayed, permanent |
| Initial Enrollment Period | 7 months around your 65th birthday |
Sources: CMS 2026 Parts A & B Premiums and Deductibles, Medicare & You 2026 Handbook
Watch: 9 Things Medicare Is Not Allowed to Do
The full video sits at the top of this page. Watch it on YouTube for the complete countdown, Dad’s story, and the three veterans.
Read Medicare for Veterans: The Complete Field Guide Free
I wrote Medicare for Veterans: The Complete Field Guide. You can read it free at freevetsbook.com or buy a copy on Amazon.
You earned Medicare. Part C can make Medicare work harder for you.
Official Sources on Medicare Coverage
- CMS 2026 Premiums and Deductibles: cms.gov
- Medicare & You 2026 Handbook: medicare.gov
- VA Health Care and Other Insurance: va.gov
- KFF Medicare Advantage 2026 Spotlight: kff.org
- Medicare Forms Library for Veterans: veteransadvantagefinancial.vet
Disclaimer
I am not affiliated with or endorsed by Social Security, Medicare, the VA, TRICARE, or any government agency. Nor would I want to be.
This is general education, not personal advice. Benefits and costs vary by county and plan. Always review your own situation before making changes.