Original Medicare doesn’t typically cover prescription medications, except in specific situations where they are administered by a medical professional. Fortunately, Medicare Part D was created in 2006, and this is the program that will help you with ongoing outpatient prescription drug therapy.
Here’s what you need to know about Medicare and coverage for prescription drugs:
Medicare Part A drug coverage
Medicare Part A covers your inpatient care, such as inpatient hospital and skilled nursing facility (SNF) stays. This generally includes drugs that are given to you as part of your inpatient care.
You may be taking routine medications on an outpatient basis at the time you are admitted into the hospital. Some hospitals and facilities may allow you (or a family member) to bring these medications from home. Check with the treating doctor at the hospital to find out their policy on taking your routine medications while you are in the hospital.
Medicare Part B drug coverage
Medicare Part B covers your outpatient care, such as doctor visits, lab work, and x-rays. You can receive outpatient care in many settings, such as the doctor’s office, the emergency room, and your home. Medicare Part B also covers certain medications that are administered to you either in a clinical setting by a medical professional.
For example, Part B covers certain vaccines such as the flu and pneumonia vaccines. It covers several autoimmune medications administered for health conditions like rheumatoid arthritis or multiple sclerosis. It also covers a variety of chemotherapy medications as well as some medications to treat side effects like nausea.
Lastly, Part B covers medications that are administered to you via durable medical equipment. For example, if you receive insulin through an insulin pump, your insulin is covered by Part B. Therefore, Medicare Part B does cover some ongoing medications. It depends on what they are and how you receive them.
Medicare Part D drug coverage
As mentioned earlier, Medicare Part D is the prescription drug coverage program for your outpatient medications, whether they are regular maintenance medications or a one-time round of something like an antibiotic. Part D has been a very popular program since it was introduced in 2006 and today it covers ongoing medication therapy for millions of Medicare beneficiaries.
Unlike Parts A and B, which you sign up for at the Social Security office and get directly from the federal government, Part D plans are offered by private insurance companies. In many counties you can find 20 or more different plan options to choose from, but all plans have the same basic structure which is standardized by Medicare itself. All plans must include certain classes of medications like anticancer drugs and antidepressants. Each plan must also cover at least two medications in every therapeutic class, so that our doctors always have options to treat new health conditions that occur.
Each Medicare Part D plan has a formulary – a list of medications the plan covers. Medicare Part D includes an amazing array of oral, topical, and even some injectable medications. Before enrolling in a Part D plan, you should review the formulary to ensure the plan covers all of your prescriptions.
Like Medicare Part B, Medicare Part D plans also cover some vaccines. For example, while Part B covers the flu, pneumonia, and Hepatitis B vaccines, Part D covers the shingles vaccine. Each Part D plan must include at least one of the two available shingles vaccines. And although the shingles vaccine is administered to you in an outpatient setting by a medical profession, Part D covers it – not Part B.
You can shop for the right drug plan by using Medicare’s Part D Plan Finder Tool.
Medicare coverage for medication is a complex subject, as you can see. Generally, Part B and Part D will cover your ongoing medications. If you’re unsure whether Part B or Part D should cover your medication, ask your provider or call Medicare before you fill your prescription.
