Many people have misconceptions regarding Medicare coverage, particularly prescription drug coverage. The four sections (A, B, C, and D) encompass a variety of healthcare services, including hospital stays and doctor visits, as well as prescription medications and other benefits.
Parts B and D of Medicare both cover prescription drugs but under separate government-mandated guidelines. While Medicare Part B only covers a limited number of prescriptions under particular circumstances, Medicare Part D covers a wider range of pharmaceuticals.
Both have premiums that depend on your income, as well as copays, deductibles, and other out-of-pocket expenses. We’ll examine the precise prescription coverage changes between sections B and D.
What is Medicare Part B?
Medicare Part B coverage includes many outpatient health and medical services, such as:
Some vaccines and medications
outpatient hospital services.
Mental health services
You will have out-of-pocket expenses for Part B, such as premiums, deductibles, and coinsurance. Prices fluctuate from year to year, and your out-of-pocket expenses are influenced by your earnings.
In 2022, the average monthly Part B premium will be $170.10, with a $233 annual deductible.
In addition, after you’ve met your deductible, you’ll have to pay a 20% coinsurance fee for certain procedures. This includes the doctor’s expenses as well as prescription drugs.
Coinsurance and other out-of-pocket expenses can be covered by Medigap supplemental plans.
Does Medicare Part B cover prescription drugs?
Some prescription medications are covered by Medicare Part B, provided you fulfill certain criteria. A health professional administers the majority of the pharmaceuticals covered by Part B.
Part B covers a variety of drugs, including:
Vaccines for influenza, pneumonia, and hepatitis B
Several injectable and infusion drugs
Certain transplant-related drugs
Nebulizers are used to provide drugs.
End-of-life drugs are used to treat patients with end-stage renal illness (ESRD).
What are the benefits of Part B prescription drug coverage?
Medications account for a significant portion of recipients’ spending. Medications account for about $1 of every $5 spent on Medicare services.
A small number of drugs account for the vast majority of Medicare Part B drug costs. Part B covers several high-priced drugs, including:
Injections for osteoporosis
Medication for ESRD
What is Medicare Part D?
The majority of outpatient medications that you might get from your local pharmacy, mail-order pharmacy, or other pharmacy providers are covered by Medicare Part D.
Part D may or may not cover prescriptions not covered by Parts A or B, depending on the plan. Private insurance companies offer plans, and there are various options depending on where you live.
During open enrollment, which takes place every year between October 15 and December 7, people can enroll. You won’t be automatically enrolled, and if you don’t have drug coverage, you’ll face a late enrollment penalty.
All Medicare plans must cover at least two drugs from the most commonly prescribed therapeutic groups.
Part D excludes the following:
weight loss or weight gain medications
Cosmetic agents, such as for hair loss
Over-the-counter medications or supplements
Part D plans must cover medications from these six classes.
Individual plan costs vary depending on:
Where do you live?
The coverage you want
What do you want to pay out of pocket?
What are the benefits of Part D prescription coverage?
Part D of Medicare is a valuable benefit that assists with the cost of prescription drugs. Although Medicare covers a substantial chunk of drug costs, you will still be responsible for a portion of them. Because the cost of pharmaceuticals has consistently risen over time, having Part D coverage can help you save a lot of money on your prescriptions.
Also, even though Part D is optional, if you don’t have drug coverage, you’ll face a penalty that will be added to your rate for the rest of your life. So, even if you don’t currently take any prescriptions, it’s a good idea to enroll in a Part D plan when you’re eligible.
How to determine the right Medicare prescription coverage for you
When it comes to Medicare Part B and Part D plans for prescription medication coverage, there are various possibilities.
They provide a variety of prescription coverage options, and it’s usually not an either/or situation. Depending on your healthcare needs, you may need both plans to save the most money on prescription drug expenses.
When choosing a plan, consider the following:
What medications are covered?
If your doctor and pharmacy are on the plan,
The out-of-pocket costs
The plan rating (5-star plans are more expensive)
If you need injections at the doctor’s office,
Each plan’s limits for medication coverage
If you need supplemental insurance,
The other costs that don’t count toward your out-of-pocket cost