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