Does Medicare Cover Medications?

Yes and No

Medicare does not cover most of the medications that are filled at a pharmacy. However, you can enroll in a Medicare Part D Prescription Drug Plan, which is offered by private insurers and goes with “Original Medicare,” or you can enroll in a Medicare Advantage Plan (Part C) with an embedded Part D plan included. Signing up for a Part D plan, even if you don’t currently take medications, is advisable to avoid potential late enrollment penalties in the future.

What Do Medications Cost?

The medications covered by Part D are categorized into five tiers, each with varying cost-sharing amounts. Tier 1 includes Preferred Generic Drugs, followed by Tier 2, which includes Generic Drugs. Tier 3 includes Preferred Brand Drugs, Tier 4 includes Non-Preferred Drugs, and Tier 5 includes Specialty Drugs. It’s essential to choose the right Part D prescription plan that suits your needs and budget because the costs for each tier vary among insurance carriers.

What About Medications That Are Injected?

If you receive injectable medications that require administration in a hospital or facility, such as chemotherapy or dialysis, those medications would be covered under Medicare Part B. Furthermore, medications received during an inpatient hospital stay would be covered by Medicare Part A. It’s important to note that if you have a Medicare Advantage Plan, your coverage for these medications would depend on the provider’s policy.

Does Medicare Cover Vaccines?

Additionally, Medicare covers limited vaccines that include influenza, pneumonia, and hepatitis B, among others. It also covers some medications that are self-administered by patients for certain medical conditions such as cancer or rheumatoid arthritis. However, it’s essential to check with your provider for the list of covered preventive services and medications under your plan.

Are All Medications Covered?

Finally, keep in mind that Medicare Part D Drug Plan coverage on medications has certain limitations and exclusions. Some medications may require prior authorization, step therapy, or quantity limits. If your medications are not on the formulary list provided by your insurance carrier, they might not be covered, and you may need to request a formulary exception process. Remember, paying out-of-pocket is also an option, and you can still use your Medicare prescription plan card to get a discounted price.

Conclusion-

If you are a baby boomer or soon to be eligible for Medicare coverage, understanding how Medicare covers your medications can save you money and time in the long run. It’s essential to understand the limitations and exclusions of Medicare. Signing up for a Part D Prescription Drug Plan or a Medicare Advantage Plan with embedded Part D is your best bet. Always do your research before choosing a carrier offering a plan that caters to your needs and budget.

Choosing the Right Medicare Coverage

Selecting the best Medicare coverage depends on factors like your healthcare needs, budget, and preferred providers. You can choose between:

Original Medicare (Parts A & B): Allows you to see any doctor or
hospital that accepts Medicare but does not include prescription drug
coverage (Part D) or additional benefits.
Medicare Advantage (Part C): Offers bundled coverage with
potential extra benefits but may require using a network of providers.
Medigap (Medicare Supplement Insurance): Helps cover
out-of-pocket costs not covered by Original Medicare, such as
copayments and deductibles.

Key Medicare Enrollment Periods

It is crucial to enroll in Medicare at the right time to avoid penalties and ensure continuous coverage:

Initial Enrollment Period (IEP): A seven-month window starting
three months before your 65th birthday month.
General Enrollment Period (GEP): From January 1 to March 31
each year for those who missed their IEP.
Annual Election Period (AEP): From October 15 to December 7,
allowing you to switch or enroll in Medicare Advantage and Part D
plans.
Open Enrollment Period(OEP): From January 1 to March 31 for
those who missed AEP and want to make certain changes.
Special Enrollment Period(SEP): Can be used anytime during the
calendar year for those that meet certain criteria such as moving to a
new service area.

Finding Help with Medicare

Understanding Medicare can be complex, but you don’t have to do it alone. Licensed Insurance Brokers, Medicare.gov, and state health assistance programs can provide guidance tailored to your specific needs.

By taking the time to explore your Medicare options, you can make informed decisions that ensure you receive the healthcare coverage that best suits your lifestyle and budget.

Do I have to sign up for Medicare?

It depends upon your current coverage. If you are employed and your employer has over 20 employees then you can delay signing up for Medicare and avoid penalties.

Does Medicare cover Prescription Medications?

No, You will have to enroll in a stand alone Part D plan or a Medicare Advantage Plan(Part C) to get coverage.

I want to be able to go to any doctor/hospital, are there networks with Medicare?

There are no networks with Medicare and most doctors and hospitals accept it. However, Medicare does not cover 100% of services so a Medicare Supplement or Medicare Advantage plans is advisable.

Mike Miligi- Owner

For over 10 years, Mike has been assisting Seniors and other Medicare-eligible individuals in understanding the ins and outs of Medicare and Medicare Health Insurance options, including Medicare Advantage Plans(Part C), Medicare Supplement Plans(Medigap), Prescription Drug Plans(PartD), and Dental and Vision programs.

Mike is Licensed in seven States and Certified with 11 Insurance Carriers. He has helped thousands of individuals decide on the best course of action for their particular Health Insurance needs. Because Mike is an Independent Medicare Health Insurance Broker, he works for the client, not the Insurance Carriers, and is able to provide his clients with accurate and unbiased Health Insurance options.

Mike recertifies with CMS(The Centers for Medicare and Medicaid Services) annually, regularly completes Continuing Education Courses required by individual State Insurance Departments, and keeps abreast of industry trends and standards to offer his clients the most up-to-date information.