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Generally, if your doctor prescribes Microzide to treat your high blood pressure (also called hypertension), Medicare won’t cover your medication outside of certain situations (described below). However, if you have a stand-alone Medicare Part D Prescription Drug Plan coverage or a Medicare Advantage Prescription Drug plan, your plan may pay for Microzide, or its generic equivalent, hydrochlorothiazide.
According to the National Institutes of Health (NIH) National Library of Medicine, Microzide can be used to treat high blood pressure, which could damage the brain, heart, blood vessels, and other organs. Microzide is in a class of medications called diuretics, which cause the body to release unneeded salt and water as urine.
When does Medicare cover Microzide?
There are four parts to the Medicare program: Part A and Part B (called Original Medicare), Part C (Medicare Advantage), and Part D (prescription drug coverage). Under Part A (hospital insurance) and Part B (medical insurance), there is generally no coverage for most prescription medications like Microzide, unless you receive them during a covered stay in the hospital or nursing facility, or they’re administered to you in an outpatient office setting.
Medicare Prescription Drug Plans are governed by the Medicare program, but are offered and administered by private insurance companies that contract with Medicare. Each plan develops its own coverage guidelines using a formulary, or list of approved medications and the benefits available for each. Under Medicare rules, plans must include a variety of prescription drugs to treat most illnesses and conditions, but benefits are determined by the individual plans. Plans may change their formularies occasionally, but they must notify you in writing when they do.
You can find out if Microzide or other medications you take regularly are included in your plan’s formulary by checking the plan website or plan materials you receive in the mail. If you aren’t currently enrolled in Part D prescription drug coverage and want to find a plan that covers Microzide, you can use the tool on this page to find a plan in your area. Just enter your zip code to get started.
How can I get Medicare Part D prescription drug coverage for Microzide?
There are two ways to get Medicare coverage for prescription drugs like Microzide:
- If you are enrolled in Original Medicare, or certain other types of Medicare health plans, you can enroll in a stand-alone Medicare Part D Prescription Drug Plan to supplement your coverage.
- You can enroll in a Medicare Advantage
Prescription Drug plan (sometimes called a MAPD) to get all your Medicare benefits in one convenient plan.
Some people with chronic conditions such as high blood pressure and heart disease find that Medicare Advantage plans meet their health-care needs better than some other types of Medicare health plans. All Medicare Advantage plans must offer at least the same coverage, at a minimum, as Original Medicare; they are simply an alternative way to get your Medicare benefits. (Note, however, that hospice benefits are still covered under Part A, even if you enroll in Medicare Advantage).
Depending on where you live and the type of plan you select, you may get additional health-care benefits in a Medicare Advantage plan, such as coverage for routine vision, hearing, and dental services. Some plans even offer discounts on gym memberships and over-the-counter medications. With a Medicare Advantage plan you will still need to pay your Part B premium.