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What Part D Covers
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Important Points
All Part D plans are required to cover at least two drugs in each therapeutic class.
There are many drugs that Part D does not cover, such as vitamins, compound medications, weight loss drugs, benzodiazepines, barbiturates, and more.
Medicare Part B covers certain types of drugs, such as drugs administered by DME, osteoporosis drugs, some oral cancer drugs, drugs administered in a physician's office, and more.
Medicare Part D plans offer a way for you to control the cost of your prescription medications. Before they were introduced in 2006, Medicare beneficiaries generally paid the entire cost of their medications or bought Medicare Supplements that, at that time, had a very limited amount of drug coverage. Medicare Part D now provides us with a much better solution.
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What Medicare Part D covers
Medicare Part D allows coverage for most retail prescription drugs in the U.S. Each individual plan maintains a list of medications that it covers called a formulary. Medicare requires that the plan must offer at least two drugs in each therapeutic class. Additionally, they cover all or substantially all drugs in six categories. These categories are antidepressants, anticonvulsants, antipsychotics, immunosuppressants, anti-cancer drugs, and HIV/AIDS medications.
These requirements ensure that any drug plan you enroll in will have many medications to treat you for future illnesses.
Additionally, Part D plans cover many common vaccines, like the shingles vaccine, to prevent illness.
There are a few types of drugs that Medicare does not require Part D plan carriers to include in their formularies. These are:
Barbiturates - sedatives or other drugs that depress the central nervous system
Benzodiazepines - these are typically prescribed for insomnia or anxiety
Compound Medications - These plans typically do not cover compounded medications. If you take a dose of a medication that is different from standard dosage, therefore requiring compounding, then you will typically pay the retail price for that drug.
Cough syrups or other drugs that treat cold symptoms
Drugs for cosmetic reasons, such as hair growth
Drugs for weight loss, anorexia, or weight gain
Fertility or erectile dysfunction medications
Prescription-strength vitamins and minerals
It is possible, in rare instances, to find a Part D insurance plan that offers these drugs anyway. However, it is their choice to do so, and each year when the drug plan is re-submitted to Medicare, the medication can be removed from the formulary for the next year if the insurance company wishes to no longer cover it.
Part B Medications
Some types of drugs fall under Medicare Part B instead of Part D. If you have Original Medicare with a Supplement plan, these medications will typically be fully covered. If you have opted for a Medicare Advantage plan instead, you will pay the plan's co-insurance as outline in your benefits summary. This Part B spending will count toward your plan's maximum out-of-pocket limit.
The categories of drugs that sometimes fall under Part B are:
Blood clotting factors
Diabetes supplies - lancets, test strips, and glucose monitors
Drugs delivered in a hospital outpatient care setting
Drugs provided in a doctor's office, such as chemotherapy
Immunosuppressive meds - often given after an organ transplant
Medications administered by durable medical equipment, such as nebulizers or internal or external pumps
Some medications that treat End-Stage-Renal failure - for example, Erythropoietin
Some oral cancer or anti-nausea medications that you administer yourself
Vaccines ordered by a doctor, such as hepatitis or pneumonia vaccines
Before you decide on a Medicare Part D plan, you will want to fully understand how Part D works and the rules and limitations that may apply to the plans that are available to you.
Working with a seasoned insurance agent that specializes in Medicare products will really help you sort through all of the rules and help you choose a suitable plan.
We provide FREE assistance to our new Medicare clients by reviewing their Part D drug plan needs and assisting them with their initial sign-up for Medicare Part D. For help from a Mohring Insurance Services LLC agent, contact us below.
Key Points
There are some drugs that Part D plans do not cover.
Part D plans cover most retail drugs, but they must be listed in your plan's formulary for your plan to pay.
Certain drugs can be covered under Medicare Part B depending on how they are administered or what health condition they are needed for.
At Mohring Insurance Services LLC, we are happy to offer assistance with Medicare Part D when you choose to enroll. Give us a call at (866) 440-1885, or to schedule a free consultation, click the link below:
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Rates are reviewed periodically and are subject to change in your state.
Cost Estimates are based on the information entered, using data about past experiences by beneficiaries with similar attributes and the premiums and benefits provided by the plan. Actual costs may vary. Monthly medical costs are represented by annual figures divided evenly per month.
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