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Does Medicare Cover Geodon?

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Generally, Geodon, the brand-name formulation of the generic drug ziprasidone, is not covered by Medicare, unless you are enrolled in a Medicare plan that includes prescription drug coverage.

Geodon is used to treat schizophrenia and certain other conditions, according to the National Institutes of Health’s Medline Plus website.

When does Medicare cover Geodon?

If you are enrolled in Original Medicare (Part A and Part B), prescription drugs such as Geodon that you take at home are generally not covered. Geodon is typically only covered if you receive it while you are an inpatient in the hospital or nursing facility during a covered stay.

If you take Geodon at home and want Medicare coverage for it, you will need to enroll in a Medicare plan that includes coverage for prescription drugs, and Geodon specifically.

How can I get Medicare Part D prescription drug coverage for Geodon?

Medicare Part D coverage for prescription drugs is provided by private insurance companies contracted with Medicare. It is available in two ways:

  • You can enroll in a stand-alone Medicare Part D Prescription Drug Plan to supplement your coverage under Original Medicare
  • You can enroll in a Medicare Advantage plan that includes coverage for prescription drugs (Medicare Advantage Prescription Drug plan).

Geodon is in a class of medications known as atypical antipsychotics, according to the Medline Plus website. It belongs to a protected class of drugs under Medicare, which means that all Medicare plans with prescription drug coverage must cover nearly all medications in that class.

To see how Geodon is covered in a particular Medicare plan, you can check the plan’s formulary, or list of approved medications. The formulary is usually available on the plan’s website. Be aware, however, that plans may change their formularies from time to time, but they are required to notify you in writing before any changes take effect (when necessary).

Because plans are administered by private insurance companies contracted with Medicare, your monthly premiums, deductibles, coinsurance amounts, and copayments may differ depending on the plan you choose and where you live. Not all plan types and benefits may be available in all locations.

Which type of Medicare Part D coverage for prescription drugs is best if I take Geodon?

Choosing between a stand-alone Medicare Part D Prescription Drug Plan that works alongside Original Medicare, and a Medicare Advantage Prescription Drug plan, is a personal decision. You may want to compare the out-of-pocket costs and benefits for each before you decide. Remember, you must continue to pay your Part B premium, plus any additional plan premium required, if you enroll in a Medicare Advantage plan.

If you think you want Medicare Part D coverage for prescription drugs, it’s important to enroll as soon as you are eligible, unless you have equivalent coverage through another source such as an employer’s plan. If you wait to enroll when you are eligible, you may have to pay an additional late-enrollment penalty every month with your premiums for as long as you have this coverage.

Would you like more information about Medicare plan options and coverage for mental illness treatment and Geodon? I’m available to answer your questions. You can request information via email or schedule a phone call at your convenience by clicking on the Get Quotes button to get started.

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