If you’ve ever been surprised by a medical bill that Medicare didn’t cover, you’re not alone. Millions of Americans believe Medicare is comprehensive…until they get hit with out-of-pocket costs, denials, or vague “not covered” notices. The truth is that Medicare is complex by design, and navigating it often feels like decoding a foreign language.
But there’s good news: within that complexity are opportunities. Legal, ethical, and little-known tactics can help you stretch your Medicare benefits far beyond what most people realize is possible. It’s not about gaming the system. It’s about knowing your rights, advocating for yourself, and using the structure to your advantage.
Here’s how to unlock more coverage, more care, and fewer financial headaches without crossing a single legal line.
How To Get The Most Out Of Medicare
1. Appeal Denials—Most People Don’t (But Win When They Do)
When Medicare denies a claim, many people assume it’s final. It’s not. You have the legal right to appeal, and a shocking number of appeals are successful. The process can feel bureaucratic, but persistence pays off. If you believe your claim was wrongfully denied, request a redetermination within 120 days of the notice. Provide medical documentation, doctor statements, and any relevant history. The system counts on people not fighting back. Don’t give them that luxury.
2. Ask for a Doctor’s “Letter of Medical Necessity”
Coverage gaps often come down to whether something is deemed “medically necessary.” If you need a treatment, piece of equipment, or service that’s not typically covered, ask your doctor to write a detailed letter of medical necessity. This letter explains why the item is critical to your health, often leading to successful claims or prior authorizations. It’s not guaranteed, but it significantly strengthens your case. And yes, it’s completely within Medicare’s rules.
3. Enroll in the Right Medicare Advantage Plan for Your Needs
Original Medicare (Parts A and B) doesn’t cover everything, but many Medicare Advantage (Part C) plans fill the gaps, often including dental, vision, hearing, and wellness programs. However, not all Advantage plans are created equal. You have the right to compare plans annually during open enrollment and switch to one that better aligns with your healthcare needs. Shop carefully, ask questions, and don’t stay loyal to a plan that no longer serves you. You deserve comprehensive coverage, not just convenience.
4. Use State Health Insurance Assistance Programs (SHIPs)
Every state offers free, unbiased counseling through SHIPs to help people navigate Medicare. These programs can show you benefits you didn’t know you qualified for, assist in appeals, and help compare plans. They won’t push you into one insurer or option because they don’t profit from your decision. These programs are one of the best-kept secrets in Medicare. Tap into their expertise. You’ve earned it.
5. Leverage “Extra Help” for Prescription Costs
If your income and assets are within certain limits, you may qualify for Medicare’s “Extra Help” program, which dramatically lowers prescription drug costs. Many people don’t apply because they assume they’re not eligible or have never heard of it. But the thresholds are more flexible than you might think, and the savings are real—lower premiums, reduced deductibles, and drastically discounted copays. Don’t leave this help on the table just because you didn’t ask.
6. Get a Care Plan from Your Doctor
Medicare Part B can cover chronic care management, but only if your provider sets up a care plan. This includes time spent coordinating your care, managing prescriptions, and keeping your treatment on track, even outside office visits. Few doctors offer this proactively, but you can request it. It’s especially helpful if you have multiple chronic conditions. The best part? You’ll receive more coordinated care while Medicare foots more of the bill.
7. Use Preventive Services Strategically
Medicare covers many preventive services at 100%, but they’re only free if you follow the schedule. That includes annual wellness visits, screenings for cancer, diabetes, depression, and vaccines like flu and COVID-19. If you skip these, you could miss early diagnosis opportunities that prevent bigger costs later. Ask your provider for a checklist of covered preventive services at the start of each year and schedule them proactively. Preventive care isn’t just good health. It’s a financial strategy.
8. Apply for Medicare Savings Programs
If your income is modest but not low enough for Medicaid, you may still qualify for a Medicare Savings Program. These programs help pay Part A and B premiums, deductibles, and even copayments. They vary by state but often fly under the radar. Even if you think you’re borderline ineligible, apply anyway. The worst they can say is no. If you’re approved, you may also be auto-enrolled in Extra Help, doubling your savings without doubling the effort.
9. Use Telehealth for Covered Visits
Telehealth services exploded in popularity during the pandemic, and Medicare expanded what it covers. As of 2025, many types of telehealth visits, including mental health, chronic care follow-ups, and primary care check-ins, are covered under Part B. These services can save money by eliminating transportation costs and reducing the need for more expensive urgent care. Plus, you get the care you need faster. Just make sure your provider participates in Medicare-approved telehealth.
10. Request a Coverage Determination for Drug Plans
If your Medicare Part D plan doesn’t cover a drug you need, you can request a coverage determination. This is a formal request asking the plan to cover a drug that isn’t on its formulary or to reduce the cost-sharing. Your doctor will need to provide a statement explaining why alternatives aren’t suitable, but many determinations are granted when well-documented. Most people accept “no” at the pharmacy counter. The smart move? Use your right to push back—legally and respectfully.
Knowledge Is Your Greatest Coverage
Medicare isn’t built to make things easy, but it is built with layers of rules you can use to your advantage if you know how. You don’t need to break the law or play games—you just need to be informed, assertive, and proactive. These strategies won’t eliminate all costs, but they can reduce surprises, expand your access to care, and give you more control over your health and finances.
Have you ever challenged a Medicare denial or found a way to get something covered that others thought wasn’t possible?
Read More:
10 Medicare Plans That Look Helpful—Until You Read the Fine Print
The Dark Side of Medicare Advantage: 5 Nightmares That Could Happen to You
