Medicare Annual Enrollment Period is Happening Now!
You Have Until Dec 7 to Make Changes to Your Coverage.
Learn more about Prescription Drug Plans
What’s the Difference Between Original Medicare Part A and B Drug Coverage and Plan D?
When deciding whether to add Medicare Prescription Drug Plan to their Original Medicare plan, or switch to a Medicare Advantage plan offering Part D, it’s important to know which medications, and the medications used in specific treatments, are covered by Parts A and B.3
Medicine Covered Under Part A (Original Medicare or Medicare Advantage Plans without Part D)
Medicare Part A may cover drugs given during treatment during a stay at a hospital or skilled nursing facility.
Medicine Covered Under Part B (Original Medicare or Medicare Advantage Plans without Part D)
Medicare Part B generally covers medicine that’s administered by a doctor during an office visit as part of a service. For example, a medication that requires an injection or infusion is usually covered by Part B. Drugs that can be taken by the patient without needing the assistance of a doctor, such as medications you get from the pharmacy, are generally not covered. Below is a list of services which Medicare Part B typically covers the drugs used during treatment:
- Vaccinations (Flu, Hepatitis B, Pneumococcal)
- Blood clotting factors with hemophilia
- Conditions treated with durable medical equipment (such as infusion pump or nebulizer)
Medicine Covered Under Part D (Available Medicare Advantage plans or added to Original Medicare coverage)
In 2019, 45 million people with Medicare are currently enrolled in plans that provide the Medicare Part D benefit. Below are some of the general requirements a drug must meet to be covered by Medicare Part D:
- Available only by prescription
- Approved by the Food and Drug Administration (FDA)
- Not covered by Medicare Part A or B
- Used and sold in the United States
- Used for a medically accepted indication, per the Social Security Act
- Included on the plan’s Part D drug list or coverage approved through an appeals process or exception