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If you are enrolled in Original Medicare (Part A and Part B), you generally do not have coverage for prescription medication you take at home, unless you are also enrolled in a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan. Here’s how you can find out if your medication is covered.
How can I find out if my prescription medication is covered by Medicare?
Under Original Medicare, there is generally no coverage for prescription drugs except in these situations:
- You get medications while in the hospital or nursing facility as part of your treatment during a covered inpatient stay (your Part A benefits apply, less any applicable deductibles and coinsurance amounts).
- You use covered Durable Medical Equipment (DME) such as an insulin pump or a nebulizer to take your medications. Medicare generally does cover certain medications and supplies used with these pieces of equipment (Part B applies, less any applicable deductibles and coinsurance amounts).
- You get certain medications, usually by injection or infusion, in a doctor’s office or outpatient center (Part B deductibles and coinsurance may apply).
- You are enrolled in hospice care under Part A (certain prescription medications to control pain and alleviate symptoms are covered under your hospice benefits).
What medications are covered under Medicare Part D Prescription Drug Plans?
Medicare Part D coverage for prescription drugs is offered by private insurance companies contracted with the Medicare program to provide these benefits. Each plan sets its own coverage rules and guidelines, subject to requirements under Medicare. These plans each use a formulary, which is a list of approved medications and the benefits available for each, to determine coverage. All Medicare Part D Prescription Drug Plans must cover a variety of medications to treat most conditions. Plans may change their formularies from time to time, but they must notify you in writing before they do.
To see if your medication is covered, you can check the plan’s formulary, which is usually available on its website.
How can I get Medicare Part D prescription drug coverage?
Medicare Part D coverage for prescription drugs is available in two ways:
- As a stand-alone plan to complement your Original Medicare benefits, as well as benefits under certain other types of Medicare health plans
- As part of a Medicare Advantage Prescription Drug plan (sometimes called an MAPD)
If you have a chronic health condition or take daily prescription medications, you may find that a Medicare Advantage plan might meet your needs. These plans are an alternative way to get your Medicare benefits in one convenient plan. By law, Medicare Advantage plans must have at least the same coverage as Part A and Part B (except for hospice, which is still covered under Part A), but they may offer additional benefits, such as coverage for routine vision and dental care, and even wellness programs. You must continue to pay your Part B premium, plus any other premium required by your plan, if you enroll in Medicare Advantage.
If you have questions about Medicare prescription drug coverage, or to see a list of plans in your area that you may qualify for, click the Get Quotes button on this page to get started.