Prescription Coverage for Medicare
Key Takeaways
- Typically, Part A and Part B won’t cover your over-the-counter prescription drugs.
- If you have Original Medicare (Parts A and B)Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). , you can add a Part DMedicare Part D is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. plan through a private insurance company.
- Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). is a private insurance alternative to Original Medicare. Medicare Advantage Prescription Drug plans include Part D coverage.
- Part D plans vary, so it’s essential to know whether a plan covers your medications.
Original Medicare (Medicare Part A and Part B) covers prescriptions administered during a hospital stay or a doctor’s office visit. But if you want Medicare to help pay for prescriptions that you pick up at your local pharmacy or have delivered to you, Original Medicare alone isn’t going to provide adequate coverage.
For the majority of your prescription needs, you’ll need to add a Part D prescription drug plan to Original Medicare (Parts A and B), or switch to a Medicare Advantage (Part C) Prescription Drug plan that includes Part D coverage.
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What Prescription Drugs Does Medicare Cover?
Part A covers most drugs administered during a hospital stay or skilled nursing facility stay. Part B covers most drugs you receive in a setting like a doctor’s office. All coverage is subject to Original Medicare’s coinsurance and standard deductibles. Here are some examples of prescriptions that Part B typically covers:- Drugs used with durable medical equipment
- Antigens prepared by a doctor and given by an appropriate provider
- Injectable osteoporosis drugs
- Erythropoiesis-stimulating agents
- Blood clotting factors
- Injectable and infused drugs
- Oral end-stage renal disease (ESRD) drugs
- Parenteral and enteral nutrition (intravenous and tube feeding)
- Intravenous Immune Globulin (IVIG) provided in-home
What Does a Medicare Prescription Drug Plan Cover?
Part D prescription drug plan coverage can vary by plan. Each plan has a drug formulary that shows what prescriptions it will pay for and how much it will pay. Each plan has its own set of deductibles and copays, and each plan has a regional network of pharmacies that will fill prescriptions within your particular plan.Have questions about your Medicare coverage?
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How Much Does Medicare Prescription Coverage Cost?
The Centers for Medicare & Medicaid Services (CMS) projected an average Part D premium for 2025 of $ $46.50 per month. The total out-of-pocket cost can vary quite a bit based on factors like:- The drugs covered
- The plan’s deductible and copays
- Where you live
When Can I Add Prescription Coverage to Medicare?
Suppose you want to add a Part D plan to Original Medicare. Maybe you want to switch from Original Medicare to a Medicare Advantage plan with prescription drug coverage. How do you add or switch coverage? If you want to add Part D to Original Medicare, your first chance is during your Initial Enrollment Period (IEP). If you enroll in Part A or Part B (or both), you can add Part D. You may also gain Part D coverage by switching from Original Medicare to a qualifying Medicare Advantage plan. If you don’t enroll during your IEP, you can still add a Part D plan during the Medicare Open Enrollment Period, also called the Annual Enrollment Period (Oct. 15 to Dec. 7). During the Medicare Advantage Open Enrollment Period (Jan. 1 to Mar. 31), you can drop, add, and switch Medicare Advantage coverage (including Part D). If you have a Medicare Advantage plan during this period, you can switch to Original Medicare and add Part D. You also could qualify for a Special Enrollment Period for certain situations like the loss of drug coverage because you ended a job. After your Initial Enrollment Period, if you don’t qualify for a Special Enrollment Period, you may face late enrollment penalties for not enrolling into a prescription drug plan.Find the Medicare Advantage plan that meets your needs.
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Sources
- Chemotherapy. Medicare.gov.
- Prescription drugs (outpatient). Medicare.gov.
- CMS Releases 2024 Projected Medicare Part D Premium and Bid Information. CMS.gov.
- Monthly premium for drug plans. Medicare.gov.
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