How Medicare Can Cover Ongoing Medication

Health

There are several parts and plans that come with Medicare, each providing different amounts of medication coverage. Medicare Part D is voluntary drug coverage that you will want to enroll in to receive prescription drug coverage when you have Medicare. However, Medicare Part A and Part B can provide coverage for specific drugs and certain scenarios. Now, let’s go into detail on how Medicare can cover ongoing medication.

Medicare Part A

Part A provides coverage when you are an inpatient at a hospital and a skilled nursing facility (SNF). If you are admitted to the hospital, Part A will usually cover all medications that you receive as part of your inpatient care. For example, if you are admitted and must have surgery, Medicare Part A will cover the anesthesia medication used during your surgery.

Part A generally covers drugs that are administered through an IV when you are an inpatient. Now, if you are admitted to the hospital and receive a pill that is inside a cup, and it is not necessarily needed to treat your condition, then Medicare Part A may not cover it. Your Part D plan will likely be billed for that certain medication.

Considering Medicare Part A only provides drug coverage while you are an inpatient in a hospital, Part A will not cover ongoing medications. With that said, Medicare Part B and Part D will provide you with a more extensive amount of drug coverage.

Medicare Part B

Part B is your outpatient care that provides coverage for preventative care, such as doctor’s visits, durable medical equipment, x rays, lab testing, and more. If you receive services at an outpatient facility, Part B usually provides drug coverage when you receive the medication through an injection or infusion. 

With that said, Part B will not cover self-administered drugs. For example, if you are in the emergency room and receive medication through an IV, Medicare Part B will cover that medication (since you are an outpatient). However, if you are sent home with medicines that you will administer yourself, it will not be covered by Part B.

Certain vaccines are covered under Medicare Part B, such as the flu shot. The flu vaccination is covered at 100% under Medicare Part B, and you can receive one flu shot per flu season. Pneumococcal shots are also listed under Medicare Part B. You will have two shots available to you throughout the year that will help you fight against the different types of pneumonia.

Medicare Part D

If you only have Medicare Part A and Part B, you will need to apply for a Part D plan. Part D plans are sold by private insurance companies and will provide you with comprehensive prescription drug coverage. Part D will not pay for medications listed under Part A or Part B and will only cover your prescription if used and sold in the United States.

Part D plans have a formulary that the private insurance company will set. The drug formulary will list the medications that the plan you enrolled in will cover. However, Medicare requires all Part D plans to include specific medications in their formularies:

  • Anti-psychotic medications
  • Anti-seizure medications
  • Antidepressants
  • Drugs to treat HIV/AIDS
  • Anticonvulsants
  • Self-administered immunosuppressive drugs

Part D plans also cover certain vaccines, such as the shingles vaccine. Part D plans must list at least one of the two available shingles vaccines on their formulary. Note that even though you will receive the shingles vaccine in an outpatient facility, Part D will provide coverage, not Part B.

With that said, certain drugs will not be covered under Part D, such as drugs for weight loss, cough and cold medicine, cosmetics, fertility enhancers, vitamins, and minerals.

As mentioned earlier, Part D plans create their own formulary. Therefore, when you are choosing which Part D plan to enroll in, you must ensure that the plan you are joining has your current medications listed on the formulary.

In summary, Part B and Part D can cover your ongoing medication needs. However, it will depend on your specific situation to know which part of Medicare will cover what drug. If you are unsure about which Medicare part will cover what medication, refer to your Part D plan’s Summary of Benefits, or contact Medicare for more information.

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