Medicare covers an estimated 60 million beneficiaries. With that many people on Medicare, you may wonder about the benefits available to so many beneficiaries. For example, does Medicare cover prescription drugs? There are four parts to Medicare – Part A, B, C, and D. Each of these parts offers some prescription drug coverage benefits. Keep reading to learn how each Medicare part differently covers prescription drugs.
The Requirements for Medicare Prescription Coverage
You are eligible for Medicare if you are:
- 65 years old or older
- Under 65 receiving disability benefits for a minimum of 2 years
- Diagnosed with end-stage renal disease
- Diagnosed with Lou Gehrig’s disease
- U.S. citizen or legal resident
If you meet the above Medicare eligibility criteria, you will automatically be eligible for prescription drug coverage through Medicare. However, you must at least be enrolled in Part A or Part B to enroll in a Medicare Part D drug plan. It is estimated that about 72% of beneficiaries have prescription drug coverage through a Part D plan.
What are the Plans that Cover Prescriptions?
As mentioned above, there are four parts to Medicare. Here are the levels of coverage based on the part of Medicare.
- Part A: This consists of your inpatient hospital stay, so this will include some of your medications during your 3-day inpatient hospital stay. Typically, these drugs are administered through an IV or infusion.
- Part B: This covers your medications given at a doctor’s office or health facility and certain oral cancer medications.
- Part C: Part C is also known as a Medicare Advantage plan. They can cover prescription costs through private HMO, PPO, private fee for service, and special needs plan choices.
- Part D: Part D is your prescription drug coverage. This plan is your go-to prescription drug plan when you are enrolled in Original Medicare. It covers most prescription drugs.
On top of this, you could get a Medicare Supplement like High Deductible Plan G that helps to cover those out-of-pocket Original Medicare costs. To learn more about this plan, visit https://boomerbenefits.com/medicare-supplemental-insurance/medicare-supplement-plans/high-deductible-plan-g/.
What Type of Drugs Does Medicare Part D Cover?
Part D plans have a list of drugs that are covered. When you sign up for a Part D plan, you can ask for the formulary, which shows the entire list.
In addition to the formulary, these types of medications must be covered as well:
- HIV and AIDS
Most plans offer generic and brand options for each of these types. There are also different tiers in a prescription drug plan. The lower the tiers are generally your inexpensive generic medications. The higher the tiers are typically the more expensive medications.
How to Find Out if Your Drug is Covered
Medicare has a tool to compare prescription drug costs and plans. This tool allows you to learn about Part D plans and Medicare Advantage plans. All you must do is input the medications you’re taking, where you fill your prescriptions, and your zip code. The tool will then show you plans in your area and their costs.
Are There Out-of-Pocket Costs for Prescriptions?
The out-of-pocket costs will differ based on where you live, what plan you’re on, and what medications you’re taking. Some out-of-pocket costs are deductibles, copays, premiums, and coinsurance. These will depend on how much you pay annually for out-of-pocket expenses.
Medicare covers millions of people each year. The four parts of Medicare offer some benefits of prescription drug coverage. You must first be eligible for Medicare to receive Medicare prescription coverage. Part D is the broadest prescription coverage you can get. However, your costs vary based on where you live. When choosing your prescription drug coverage, make sure that you select the plan that fits your needs best.