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What drugs are covered by Medicare Part D?

Prescription pills in plastic medicine bottles.

Are you interested in seeing what Medicare Part D plans may be available in your area? Contact MedicareInsurance.com by phone at (800) 950-0608 for assistance!

Just the Essentials…

  • Medicare Part D is the portion of Medicare that is primarily responsible for prescription drug coverage.

  • Like Medicare Part C (Medicare Advantage), Medicare Part D plans are offered by private insurance companies, meaning costs, benefits, and the exact drugs you can expect to be covered will vary from plan to plan.

  • Medicare Part D can usually be bundled as part of a Medicare Advantage plan, but it can also be offered as a standalone coverage option as well.

  • The licensed agents at MedicareInsurance.com can help you research and compare Medicare Part D plans in your area today!

First of all, what is Medicare Part D?

All across the nation, many Medicare beneficiaries rely on prescription medications to maintain their quality of life. This includes those over the age of 65 and those who have been diagnosed with certain diseases or disabilities.

Medicare Part D is primarily focused on Medicare drug coverage, and is responsible for helping you pay for the costs associated with prescription medications. Like Medicare Advantage, Medicare Part D plans are offered by private insurance providers. 

As a result, the exact pricing, benefits, and drugs you are eligible to receive coverage for can vary from plan to plan (especially depending on your location), but most common outpatient drugs can be covered by Medicare Part D. Medicare Part D coverage can usually be bundled into a Medicare Part C (Medicare Advantage) plan, but Part D can also be had as a standalone plan as well.

Does Medicare pay for prescription drugs?

With a Medicare Part D plan, you may be eligible to receive full or partial coverage for many common prescription medications that are considered to be medically necessary. However, like other insurance plans, you will usually be responsible for meeting plan deductibles and paying premiums, copays, and coinsurance out-of-pocket.

Typically, these out-of-pocket costs are low, and you may even be eligible to receive additional financial assistance in paying for your medications via cost-saving programs like Extra Help through Social Security.

What medications are covered by Medicare Part D?

Each Medicare Part D plan has a list of prescription drugs and medications that are covered. This list is called a formulary, and is usually formatted by drug category. Drug categories are classified based on medications that are intended to treat the same types of illnesses by targeting similar symptoms or by having similar effects on one’s body.

All Medicare part D plans are required by law to include coverage for at least two drugs from most categories, and all drugs that fall under the following categories:

  • HIV/AIDS treatment
  • Antidepressants
  • Antipsychotics
  • Anticonvulsants and medications intended for seizure disorders
  • Immunosuppressants
  • Anticancer treatments (unless covered under Medicare Part B) 
  • Most vaccines (unless covered by Medicare Part B)

What about Medicare insulin coverage?

Some Medicare Part D plans may also offer coverage for medications such as insulin, which is a vital part of diabetes management for many seniors. Currently, insulin is not covered under Original Medicare Parts A and B, and neither are insulin-related supplies such as alcohol swabs, needles, syringes, or gauze.

What medications are NOT covered under Medicare Part D?

Unfortunately, there are several categories of drugs that are not covered by Medicare at all, and this includes any currently available Medicare Part D plan. Typically, these medications are sold over-the-counter, or not considered to be medically necessary for Medicare beneficiaries.

Examples of many common medications that are not covered by any part of Medicare health insurance plans include:

  • Drugs designed primarily for weight loss or weight gain
  • Drugs designed to promote fertility
  • Drugs designed for cosmetic purposes, such as hair growth
  • Over-the-counter cough suppressants, cold, and flu medications
  • Drugs designed to treat erectile dysfunction

If your desired medication is not listed on your Medicare Part D plan’s formulary, and is not covered by Original Medicare Parts A and B, you may need to request an exception, file a formal appeal, or pay for your medication out-of-pocket.

How do I enroll in a Medicare Part D: Prescription Drug Coverage plan?

If you are interested in getting covered for your medically necessary prescription drugs, a Medicare Part D plan is usually a great way to go. 

At MedicareInsurance.com, we employ licensed agents who are friendly, experienced, and more than happy to help you research and compare Medicare Part D and Medicare Advantage plans that are currently available in your area.

Simply give us a call today at (800) 950-0608 to get started!

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