According to Medicare Rights, over 80% of senior citizens take at least two prescription drugs daily. If you have a chronic health condition, you may have to take more than just two medications every day. If one of them is a branded prescription drug, you could spend over $5,800, according to AARP.
Prescription drug prices are steadily increasing. With the average Social Security benefit being $1,503 a month (according to U.S. News), medication costs are unaffordable for many seniors if they don’t have prescription drug coverage. The question is, will Medicare cover for prescription drugs?
Medicare Part B prescription coverage
Medicare Part B covers most outpatient services such as doctor’s visits, preventative care, and durable medical equipment.
If you receive care at an outpatient facility, Part B will likely cover any prescription drug administered by a healthcare provider. In other words, if you can take a drug home and administer it yourself, then Part B will likely not cover the drug.
For example, suppose you visit an emergency room and get IV medication. Part B will generally cover the drug since it’s administered by a health professional. If you are released from the emergency room with a prescription to fill at the pharmacy, Part B won’t cover it.
Several vaccinations are covered by Part B, such as the flu and pneumococcal vaccines, and the hepatitis B shot. These are considered preventive care, which is covered by Part B at 100% and the Part B deductible doesn’t apply.
Medicare Part D prescription coverage
Medicare Part D is prescription drug coverage, which is the insurance you will use to help cover your medications. If you do not enroll in a Part D plan and you don’t have prescription drug coverage from another source, you will pay 100% of the cost of your drugs.
Part D plans are not offered by the federal government, like Original Medicare. Private insurance companies sell Part D plans. The insurers also determine the plan’s formulary, which is a list of medications covered by the plan and your cost for each. Medicare requires all Part D plans to cover certain medications, however. These include:
- Immunosuppressive medications
- Anti-seizure medications
- Antipsychotic medications
- Medications to treat HIV/AIDS
Part D plans also cover certain vaccines, such as the shingles vaccine. Every Part D drug formulary must cover at least one of the two shingles vaccines.
On the other hand, there are certain drugs that Part D plans will not cover, such as medications for:
- Erectile dysfunction
- Fertility support
- Weight loss
- Hair growth
- Over the counter cough syrups
When you choose a Part D plan, make sure it covers any medications you take on a daily basis. , If it’s not and your doctor can’t find a suitable substitute on the formulary, you will pay 100% for the drug until you can enroll in a new Part D plan during the Annual Election Period.
Medicare Part A prescription coverage
Medicare Part A covers your inpatient hospital and skilled nursing facility stays. If you are admitted to the hospital, Part A usually covers any medication you are given for treatment during your hospital stay. For instance, if you are given hydrocodone to treat pain as an inpatient, Part A should cover the drug. Part A is solely inpatient hospital coverage and does not cover any medications you take at home.
In summary, Medicare will likely cover your prescription drugs. However, it will depend on your particular situation to know which part of Medicare will cover what drug. To learn more about your plan’s drug coverage, refer to your Part D’s Summary of Benefits, or visit Medicare.gov for more information.