Does Medicare Cover Medicine?

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The Journal of the American Medical Association reports that 59% of American adults were taking at least one prescription drug in the years 2011 and 2012. The prevalence of drug use begs the question of whether or not Medicare provides coverage for all this medicine.

To answer the question briefly, Medicare does provide coverage for some medication. However, there are many things to know regarding what medicine is and isn’t covered.  

Medicine Coverage Under Original Medicare

A limited amount of prescription drug coverage is available under Original Medicare. Drugs that are administered during inpatient hospital treatment may be covered by Medicare Part A. Part B of Medicare can include coverage for the following types of outpatient medicine:

  • Antigens
  • Injectable osteoporosis drugs
  • Injections and oral medicine for the treatment of End-Stage Renal Disease
  • Injections of blood clotting factors to treat hemophilia
  • Certain nutrients for intravenous or tube feeding
  • Intravenous Immune Globulin (IVIG) for the treatment of primary immune deficiency disease
  • Vaccinations for the flu, Hepatitis B and Pneumococcal disease. Other vaccines may be covered when directly related to the treatment of an injury or illness.
  • Transplant (or immunosuppressive) drugs
  • Oral cancer drugs
  • Oral anti-nausea drugs

For prescription drugs received in a doctor’s office or pharmacy, Medicare Part B enrollees will typically be responsible for 20% of the Medicare-approved amount once the Part B deductible is met. Drugs that are received by a hospital outpatient require a copayment that can vary in cost.

Medicare Part A covers certain prescription drugs related to pain relief and symptom control during hospice care. These drugs require a copayment of no more than $5.  

The coverage parameters for specific drugs and medications can be found on Medicare.gov.

Additional Medicare Drug Coverage

Medicare Part C and Part D also offer drug coverage in various forms.

Medicare Part D consists of an optional collection of prescription drug plans that can be used in combination with Original Medicare. Each drug plan will vary in regards to the drugs that are covered, the amount at which they are covered and the overall cost of the plan. Medicare Part D plans may come with premiums, deductibles, copayments and coinsurance.

Medicare Part C, better known as “Medicare Advantage,” is a collection of plans that offer the same coverage as Original Medicare while also offering additional benefits that vary by plan. Some of the added benefits may include a Medicare Part D plan (MA-PD). Medicare Advantage plans may also come with their own out-of-pocket costs that can vary from insurer to insurer.

Additional Ways to Save

An additional way to save money on medication through your Medicare coverage is with a Medicare supplement (or “Medigap”) plan. These plans are used in combination with Original Medicare to provide coverage for out-of-pocket costs such as deductibles, copayments and coinsurance.

There are eight Medigap plans that offer full coverage for the Medicare Part B coinsurance, meaning the 20% cost-sharing requirement for covered medicines can be covered in full. An additional two plans offer partial coverage for Medicare Part B coinsurance.

There are also two Medigap plans that offer full coverage for the Part B deductible, an amount which must be met before any drug coverage can begin.

To compare the basic benefits of all 10 standardized Medigap plans, refer to the chart below.

For more information about Medicare Supplement Insurance, speak with a licensed agent at 888-264-0148.

To learn about the other services that Medicare covers, read through our guide, What Does Original Medicare Cover?

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Sources:

Medicare.gov: https://www.medicare.gov/coverage/prescription-drugs-outpatient.html

https://www.medicare.gov/coverage/your-medicare-coverage.html

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