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.
Frequently Asked Questions
Are all my medications Free?
Some Generics will be at a preferred Pharmacy. Others that are Tier 3 and above will have copays.
Do Part D Drug Plans have Deductibles?
Yes, most do but some do not and you will have to pay a higher monthly premium.
Does Medicare cover any medications?
Yes, injectable medications and infusions are covered by Medicare part B.
Mike Miligi- Owner- Michael M Insurance Services
For over 10 years Mike has been assisting Seniors and other Medicare eligible individuals understand 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 7 States and Certified with 11 Insurance Carriers and 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.
