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What Does Medicare Part D Cover? – Frequently Asked Questions

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According to the Centers for Disease Control and Prevention, almost 50 percent of Americans have used at least one prescription drug in the last 30 days. However, Original Medicare (Medicare Part A and Part B) generally does not cover most prescription drugs you take at home. For most prescription drug coverage you will need Medicare Part D offered by a private insurance company. You can get Medicare Part D through a stand-alone Prescription Drug Plan or a Medicare Advantage plan with prescription drug coverage. You can get a stand-alone plan to go along with Original Medicare. Medicare Advantage is another way to get all your Medicare benefits in one plan. (Only hospice care is still covered through Medicare Part A.)

Prescription medications

All Medicare Part D plans don’t necessarily cover the same prescription drugs. Each Medicare prescription drug plan has a list of covered drugs called a formulary. The formulary may change at any time but the plan will notify you when necessary. Most Medicare prescription drug plans place medications on different tiers, with each tier corresponding to a different cost. Prescription drugs on lower tiers generally cost less than those on higher tiers. You can search for a plan that covers the prescription drugs you are currently taking.

Over-the-counter medications

Generally Medicare Part D does not cover over-the-counter medications such as Advil, Benadryl, or Pepto-Bismol. Some Medicare Advantage plans, sometimes referred to as Medicare Part C may cover over-the-counter items as supplemental benefits. .  Although, Medicare drugs plans are not required to cover over-the-counter drugs there are some exceptions, some plans may cover them as an added benefit.

Vaccines

Medicare Part D generally covers all commercially available vaccines that are reasonable and necessary to prevent illness. Examples of vaccines the most Part D plans cover include the Tdap vaccine and the shingles vaccine. The only vaccines that Part D generally doesn’t cover are those covered by Medicare Part B, such as the flu vaccine, the hepatitis B vaccine and the pneumococcal vaccine for pneumonia.

Medications excluded from Part D coverage

According the Centers for Medicare and Medicaid Services, certain prescription drugs are excluded from Part D coverage. These include but are not limited to:

  • Agents for hair growth
  • Agents used for weight loss and weight gain
  • Prescription vitamins and minerals
  • Over the counter smoking cessation medications
  • Barbiturates
  • Blood glucose testing strips

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