Knowing what your Medicare plans will cover, or will not cover, isn’t always an easy task. For instance, you may visit your pharmacy to pick up prescriptions assuming the Medicare Part B plan that you have will cover your medications. Unfortunately, Medicare Part B doesn’t provide coverage for most prescription medications unless they’re physically administered by a healthcare provider.
There is, however, a Medicare plan that will cover the cost of most prescription medications that you purchase. It’s known as Medicare Part D, which is a plan designed exclusively for coverage of prescription medications.
Like any Medicare plan, Medicare Part D has specific limitations. Because these plans are offered by private health insurance companies, so the scope of what particular Medicare Part D plans cover or will not cover depends on a few different factors, including:
- The company that’s offering the Part D plan.
- The area that you live in.
- The purpose of your needed medication.
Still sounds kind of complicated, right? Well, our friends at MedicareInsurance.com are here to help make a little more clear the types of medications that Medicare Part D plans will or will not cover. Read on to learn whether or not the medication that you need may be covered by your Part D plan!
Medicare Part D is Designed to Offer Coverage for Prescription Medications
Some may think that the Original Medicare plans, Medicare Part A and Medicare Part B, offered by the federal government cover costs for prescription medications. While this is partially true, the fact is that Medicare Part A and Medicare Part B do not offer coverage for prescription medications that you pick up and administer on your own. They offer coverage for prescription medications that are administered by your healthcare provider.
There’s good news to glean out of that, though. There are private health insurance companies that offer certain Medicare plans that provide coverage that Original Medicare does not. One of those plans is the Medicare Advantage plan, which provides coverage for the same services and treatments covered by Original Medicare, but expands to include coverage for dental, vision, hearing, and sometimes more. The other plan offered is a Medicare Part D Prescription Drug plan, which can be bundled with Medicare Advantage or purchased as a standalone plan.
Medicare Part D plans are called prescription drug coverage plans because they are designed specifically to offer coverage for many self-administered prescription medications. Like any other health insurance plan, you may be responsible for certain out-of-pocket costs, but these costs are relatively low.
What Kinds of Medications Will Medicare Part D Cover?
All Medicare Part D plans come with a list of prescription drugs and medications that they will cover. This list, known as a formulary, is often formatted by category and classifies medications that are intended to treat the same types of illnesses. Medicare Part D plans are required by law to cover at least two medications from most categories, and all medications that fall under the following categories:
- Treatment for HIV/Aids
- Antidepressants and antipsychotics
- Medications for seizure disorders, including anticonvulsants
- Anticancer treatments
- Most vaccines
Many Medicare Part D plans offer coverage for diabetic medications, such as insulin. As of this year, the cost of insulin for seniors who are Medicare beneficiaries has been capped at $35. While Medicare Part B covers certain diabetic supplies and services, it currently does not offer coverage for insulin that is self-administered, i.e. insulin that is not administered by a healthcare professional or by pump.
What Kinds of Medications Will Medicare Part D Not Cover?
Certain medications are not covered under Medicare Part D plans for certain reasons. For example, over-the-counter medications are not covered, nor are medications that are not considered to be medically necessary.
Some examples of medications that are not covered by any part of Medicare insurance include:
- Drugs designed for weight loss or gain
- Fertility medications
- Cosmetic drugs, such as supplements for hair growth
- Over-the-counter medications, such as cold and flu medicines
- Medications designed to treat erectile dysfunction
If you need a specific medication that you feel may not be covered by your Part D plan, check your formulary. If the medication you need is not listed in your formulary, and/or is not covered by Original Medicare, you may need to request an exception, file a formal appeal, or pay the out-of-pocket cost for your medication.
How to Enroll in a Medicare Part D Prescription Drug Plan
Are you interested in getting coverage for the medications you need? Start your search today for health insurance providers in your area that offer Medicare Part D plans.
Did you know that our friends at MedicareInsurance.com can help you with your search for a plan? They make finding a plan incredibly easy, and their knowledgeable licensed insurance agents can answer any questions you have about the ins and outs of Medicare Part D plans in your area. Give them a call today at (800) 950-0608 to start learning more about Medicare Part D plans near you.
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