Getting Medication Covered by Medicare

Medicare is the primary source of health insurance benefits for millions of senior citizens and other qualifying Americans. While it is very expansive, it does not automatically cover every health care cost that you might face. One of these uninsured costs is the cost of prescription medication.

Still, the Medicare program is very expansive, so even though Original Medicare (which is the primary and foundational component of the Medicare system) might not cover prescription drugs, there are plenty of resources available for you to get this coverage. Medicare as a system offers quality prescription drug benefits through both the Medicare Advantage program and through Medicare Part D prescription drug benefits. Here’s how they work.

Medicare’s Prescription Insurance

Original Medicare is the core, primary government-supported health insurance program provided to most Americans when they turn 65 years old. Others with qualifying disabilities or chronic health conditions may also qualify for benefits. a stack of flyers on a table

The Original Medicare program contains two essential benefits: Medicare Part A & Medicare Part B. Part A covers hospital costs like surgeries, tests and admissions. Part B covers costs like your regular checkups and related physician services.

Still, what you won’t find within either Part A or Part B coverage is prescription drug benefits. Part A will only provide a very limited set of drugs, usually limited only to those received through IV treatments or given during inpatient stays in hospitals. Still, your everyday, run-of-the-mill prescription costs will not have coverage under Medicare Part B.

Given that prescription medications are taken daily by millions of Americans, they are usually among the most frequent and substantial costs within your medical budget. That’s why quality prescription drug benefits will substantially reduce your out-of-pocket costs for these essential needs and enable you to afford the drugs that you need to remain healthy. After all, by being able to afford your medication, you won’t have to choose between taking your medicine or skipping it because you can’t afford it.

Medicare Prescription Drug Insurance

The primary Medicare prescription drug benefit is called Medicare Part D. This is specific prescription drug coverage that is provided by private insurers, but that still must meet standards set by federal Medicare regulations. Once you are enrolled in both Medicare Part A & Part B, you can add Part D benefits on the side as supplementary coverage. While you will have to pay a premium for coverage, you will usually pay a very affordable cost, nonetheless.

There are numerous Part D plans on the market, and though they must meet certain standards set by law, they can still differ based on the carrier that offers them. Each plan will offer different formularies, pricing tiers and cost-sharing options for all participants.

However, most Part D plans will cover the most-necessary drugs for the majority of Americans. They will also offer a choice of drugs so that patients can choose the one that best suits their needs. Your physician and insurer can work with you to choose the most cost-effective drugs.

Medicare Advantage Insurance

In addition to Part D plans, you can also get prescription drug coverage if you enroll in a Medicare Advantage plan.

Medicare Advantage plans, also called Part C coverage, are essentially enhanced versions of Original Medicare. They will offer all of the coverage of Part A & Part B. However, they will also offer additional coverage like dental, vision, and yes, prescription drug benefits, within the same package. However, they are sold by private insurers, and often offer a different provider network than the Original Medicare system.

Like with Part D plans, the prescription benefits within Medicare Advantage plans must meet certain standards. However, carriers do have leeway to choose their own formularies, tiers and cost-sharing rules to a certain extent. Therefore, when investigating your Medicare Advantage enrollment options, it’s important to work with your Medicare agent to determine which one offers you the most optimized coverage and cost benefits.

However, please note that you usually will not need both Medicare Advantage and Part D coverage at the same time. Nevertheless, if your Advantage plan does not offer prescription coverage, you might be able to enroll in Part D. Your provider can help you make this determination.

Our job is to help every client get the Medicare benefits that are best for them, which is why we’re committed to making sure your Medicare prescription benefits are right for you. Just come to us when you need assistance, and we’ll be by your side to get you the perfect coverage solutions.

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