Do You Have Medicare Prescription Coverage?


The cost of prescriptions is high, and a recent study found that 23% of older individuals report having difficulty affording their prescription drugs. For the majority of Americans, affordable prescription coverage is crucial. The best part is that thousands of Medicare plans are available that can reduce the cost of prescription medications. Prescription benefits are provided by several elements of Medicare depending on the particular plan you select. Based on fulfilling certain plan requirements, Medicare Part D gives the most comprehensive pharmaceutical coverage. Yet, other components of Medicare also provide varying degrees of prescription coverage.

Medicare Prescription Medicine Plans

Hospital (Part A), outpatient medical (Part B), prescription medicines (Part D), and Medicare Advantage (Part C), which includes many of these alternatives as well as a few extras, are the four main portions of Medicare, each of which offers a different set of benefits.

Part A (Hospital)

When specific conditions meet, Medicare Part A includes hospital stays, some skilled nursing facility stays, hospice care, and at-home medical care. In general, insurance covers any medications you obtain as part of your treatment. If Part A doesn’t cover your drugs during a stay in a skilled care facility, your Part D coverage might. Skilled nursing, hospice, and home healthcare plans do not have deductibles. There can be a minimal fee for drugs under hospice care.

Part B (Medical)

Part B offers coverage for a small number of prescription drugs that administers in a doctor’s office, dialysis facility, or other outpatient hospital settings. A trained medical professional with a license must give the drugs. Part B does cover some antinausea and chemotherapy drugs for oral cancer.

Part C (Medicare Advantage)

HMO and PPO options are available in Medicare Advantage plans. Also, there may be possibilities for additional services like dental, vision, and hearing under these plans. You have the option to select Part D coverage as one of your benefits if you sign up for a Medicare Advantage plan. Part C cannot be combined with a different Part D plan for prescription coverage. And part A and Part B medications must be covered by all Part C plans.

Part D (Prescription drug coverage)

FDA-approved prescription drugs that are not covered by Part A or Part B are covered by Part D insurance. The formulary, or list of approved medications, for the particular plan you select, determines which medications are covered. Your out-of-pocket expenses, such as deductibles and copays, affect the cost of your prescription drugs. Some drugs that Part D does not cover are:

  • Over-the-counter drugs
  • Cosmetic substances
  • Medications for fertility
  • Medicines for weight loss

For Whom are Medicare Prescription Medication Programs Available?

When you become eligible for Medicare, you are also eligible for prescription medication benefits. Most people become eligible three months prior to or three months following their 65th birthday. Also, you are eligible for Medicare and will enroll in Parts A and B automatically if you receive Social Security benefits. You might qualify for Medicare before you turn 65 if you have ESRD.

Also, you are eligible from three months before to three months after your 25th month of receiving benefits provided you have been receiving Social Security disability benefits for at least two years. Also, you can sign up for a Medicare Advantage or Part D plan. If your current plan no longer offers coverage, you move to a location where it does not, you are eligible for further assistance, or other exceptional circumstances apply, you can also sign up for Part D coverage or change plans.

The Bottom Line

Medicare offers a few alternative options to cover prescription drugs. Depending on where you reside, there are thousands of Part D plans and Medicare Advantage plans that you can pick from. Little prescription coverage is provided by Parts A and B. Based on the prescriptions you take and the plan’s out-of-pocket expenses, select the best plan.