Does Medicare Cover Drugs?

Learn if Medicare covers drugs

by Katie Banks+ on Jun 01, 2015 | 5 Comments

Drug costs can be one of the most expensive things about getting older. There are different types of drugs: prescription drugs and doctor administered drugs. Many Medicare-eligible persons are curious as to if and how drug coverage is covered by Medicare. Let us explain if prescription drug coverage and administered drugs are covered.

Does Medicare Cover Drugs?

Medicare does NOT pay for prescription drugs at the pharmacy; however certain drugs administered by a doctor are covered partially by Medicare Part B.

Does Medigap Cover Drugs?

A good rule of thumb is if Original Medicare doesn’t cover it, then Medigap doesn’t either. Therefore, Medigap does NOT prescription drugs, but it covers some of the costs of approved doctor administered drugs. Medigap plans can pay all or part of the Medicare gap in coverage for administered drugs.  Most people with a Medigap plan purchase a separate stand alone Part D plan (see below).

Learn More about Medigap Get a Medigap Quote

Does Medicare Advantage Cover Drugs?

Most Medicare Advantage (MA)  plans cover prescription drug and approved doctor administered drugs. Medicare Advantage plans that cover drugs are called MAPD. Each MA plan that covers drugs has a slightly different list of drugs covered so it is important to check before purchasing a plan.

Learn More about Medicare AdvantageGet a MA Quote

Stand-Alone Drug Plans

Stand-alone prescription drug plans, known as Medicare Part D, are available to everyone except those with Medicare Advantage (MAPD). Over 90% of Americans on Medicare select part D coverage.  The national average cost is $35 a month. Click here to get a Part D quote. To get a customized quote for your exact drug costs, call a Senior65 agent at 800-930-7956.

 

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Reader Comments and Questions

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By Lee on November 14, 2015

For Part D, I read that "the standard benefit in 2016 has a $360 deductible and 25% coinsurance up to an initial coverage limit of $3,310 in total drug costs." On top of that, according to the article above, the average premium for part D is $35. I take only one drug, it's the generic version of Lipitor, and without any insurance it is $30 a month. So does it still make sense to get a part D plan? Seems I'd be paying much more. Thanks

Lee,
We totally understand why you would consider holding off on a Part D plan. Here are a few things to consider before delaying enrolling in a prescription drug plan 1) If you don't enroll when you're first eligible you could owe a penalty of 1% for every month that you could have enrolled but did not; 2) There are plans that are quite a bit less expensive than the national average; and 3) If you were to start taking any other drugs during the year, you would have to pay out of pocket for those costs until you are able to enroll in a Part D plan. Hope this helps!
-Chris from https://www.senior65.com/


By Reg on September 17, 2015

I take Atorvastatin 10 mg & my wife take Losartan 12.5 mg. Does Medicaid cover these? Is it worth getting a drug plan?

Reg,
I just verified your drugs in our drug finder, both are covered by Medicare Part D (prescription drug plan). There are two reasons why we suggest getting a drug plan: 1) In case of emergency, 2) If you don't enroll when 1st eligible you can owe a Part D penalty. Hope this helps.
-Amy from https://www.senior65.com/


By Eve Brown on September 03, 2015

Can I purchase both a Medigap plan and a stand alone drug plan?

Eve,
Good question! And, yes, you can purchase a stand-alone drug plan and a Medigap plan.
-Jacima from https://www.senior65.com/


By Avi B. on August 13, 2015

I take a few drugs because I had a heart attack a few years ago. You think Medicare Advantage with an included drug plan or Medigap with an added drug plan is better. Money is not an issue ( I have some investment property), I just want to choose the right one for me. Thank you for your advice.

Avi,
If money is not an issue, we generally recommend Medigap F and a stand-alone drug plan. The reason is with Medigap you'll have a nationwide network of doctors and hospitals, usually no out of pocket expenses for health care after your premium, and there are usually more drug plans to choose from than the plans attached to a Medicare Advantage plan. Hope this helps.
-Chris from https://www.senior65.com/


By Ilya on August 05, 2015

Do I need a drug plan? I'm not taking any drugs right now.

Ilya,
You don't need a drug plan, but you may want to get one for a few reasons: 1) If for some reason you would need to take a drug it can save you a lot of money by being enrolled in a Part D plan; 2) If you didn't enroll when first eligible, and need a drug plan, there are only limited times each year in which you can enroll; and 3) If you choose to enroll later (and do not have other drug coverage) you can owe a 1% penalty for each MONTH you did not have a prescription drug plan. Hope this helps.
-Amy from https://www.senior65.com/



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