Medicare provides healthcare coverage for seniors who are age 65 years or older and others with specific disabilities. Original Medicare covers inpatient and outpatient services, but what about prescription medication? According to Medicare Rights, over 80% of senior citizens take at least two prescriptions daily. Some prescription medications can be expensive, especially if you have a chronic health condition.
With this data, many would assume that Medicare covers prescription medication. However, the different parts of Medicare cover different things. So, the question is, does Medicare cover prescription medication?
When you enroll in Medicare, you will need to purchase a standalone Part D plan (unless you have a Medicare Advantage plan) for prescription drug coverage. Medicare Part D is coverage specifically for prescription medications, and it covers most prescription medications in the United States.
Medicare Part D plans are sold through private insurance companies, not the government. If you fail to enroll in a Part D plan and do not have a form of creditable coverage for Part D, you will pay the full price for your prescriptions that fall under Part D and will receive a late enrollment penalty.
Each Part D plan has a set formulary of which drugs the plan will cover. However, each Part D plan must offer at least two drugs in each therapeutic class. Within those therapeutic classes, Part D plans will cover all drugs in these six categories:
There are a few vaccinations Part D plans must also cover, such as the shingles vaccine. However, there are some prescription medications that Part D plans do not have to cover:
Although Part D carriers do not have to list these medications on their formulary, it does not mean you will not find a plan that covers those prescriptions. Each year a carrier can change the medicines listed on its formulary, so you will want to ensure your medications are listed on the set formulary before the Annual Election Period in case you need to enroll in a different plan.
There are medications that Medicare Part D does not cover, and one reason is that some medicines fall under Medicare Part B. Medicare Part B covers outpatient services. Therefore, it will likely cover drugs you receive at an outpatient facility if administered by an infusion or injection.
For example, suppose you visit the emergency room, and a healthcare physician administers your medications through an IV bag. In that case, Part B will cover the medication since you are receiving it at an outpatient facility, and you are being administered the medication.
Now, if you are discharged from the emergency room and pick-up a prescription from a pharmacy that you can administer yourself at home, then it will not be covered by Medicare Part B and will likely be listed under Part D.
Medicare Part B covers many vaccinations, such as the COVID-19, flu, hepatitis B, and pneumococcal, vaccination. Medicare Part B considers these vaccinations as preventative services. Therefore, you will not have any out-of-pocket costs for these vaccines.
Knowing that Part B and Part D cover many prescription medications, you will also find that Medicare Part A provides some prescription medication coverage.
Medicare Part A is coverage for hospital inpatient services and skilled nursing facility stays. When you are an inpatient at the hospital, Part A typically covers the medications you will receive as an inpatient. For example, if you are an inpatient and are administered morphine for pain-alleviation, then Part A will likely cover that medication.
Part A is strictly coverage for your inpatient needs, so it will not cover any medication that you do not receive inside a hospital or skilled nursing facility as an inpatient.
In conclusion, Medicare does cover prescription medications. However, it depends on your particular situation to know which part of Medicare will provide coverage. If you are unsure if your Part D plan covers a specific medication, check your plan’s formulary, or contact your carrier for more information.
