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Does Medicare Cover Cold Medicine?

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The common cold is a viral infection of the upper respiratory tract, including the nose and throat, according to the Mayo Clinic. Symptoms of the common cold include:

  • A runny or stuffy nose
  • Sore throat
  • Cough
  • Congestion
  • Sneezing
  • Slight body aches
  • Low-grade fever
  • Feeling generally unwell

Because the infection is caused by a virus, antibiotics won’t help a cold, according to the U.S. National Library of Medicine. However, different cold medicines may help with symptom relief.

What types of cold medicine are available?

Different types of cold medicine do different things to relieve cold symptoms, according the U.S. National Library of Medicine. Some cold medicine may help you go about the tasks of your daily life despite having a cold. However these over-the-counter cold medicines won’t prevent a cold or shorten its duration, according to the Mayo Clinic.

  • Nasal decongestants unclog a stuffed up nose. These cold medicines could include oral decongestants such as Sudafed or nasal decongestant spray such as Sinex Spray.
  • Cough suppressant cold medicine can quiet a cough such as Robitussin or Vicks 44.
  • Expectorant cold medicine such as Guaifenesin loosen mucus so you can cough it up.
  • Antihistamine cold medicine stop runny noses and sneezing such as Benadryl and Claritin.
  • Pain relievers such as Tylenol, Advil and Motrin lower fevers, and help with headaches and minor aches and pains

Taking cold medicine should not replace seeing a doctor if you have a fever greater than 101.3 F, a fever lasting five days or more, wheezing or shortness of breath, according to the Mayo Clinic.

Does Medicare cover cold medicine?

Many cold medicines are available over-the-counter, meaning you do not need a doctor’s prescription. Medicare Part A and Part B generally do not cover over-the-counter medications you take at home. Medicare Part D prescription drug coverage also does not generally include over-the-counter drugs under the Part D benefit. However, Medicare Advantage plans may offer over-the-counter cold medicines as a supplemental benefit under Part C. Specifically, Medicare Advantage may cover medicines or sprays with an active medical ingredient that alleviates symptoms, including cold medicines such as antihistamines and decongestants.

Medicare Advantage plans, which are offered by private companies, must cover everything that Original Medicare (Part A and Part B) covers with the exception of hospice care, which is still covered by Part A. Medicare Advantage plans may also cover additional benefits that Medicare Part A and Part B don’t usually cover, such as cold medicine, prescription drugs, wigs for cancer patients, and wellness programs.

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