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Medicare Part B vs. Medicare Part D


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If you’re approaching Medicare eligibility, you may have questions about what each part of Medicare covers. Medicare Part A and Medicare Part B are considered Original Medicare, Medicare Part C is the Medicare Advantage program, and Medicare Part D is prescription drug coverage.

This article will break down Medicare Part B and Medicare Part D to help you understand how each part covers prescription medication.

What is Medicare Part B?

Some people think of Medicare Part B as the “outpatient” part of your Medicare coverage.

Medicare Part B typically covers your doctor visits, diagnostic tests, and other services and supplies. Medicare Part B also generally covers preventive care, such as annual wellness visits, health screenings, and certain vaccines. Medicare Part B may also cover certain types of outpatient medications.

Medicare Part A generally covers inpatient care – in a hospital or skilled nursing facility, for example.

If you enroll in a Medicare Advantage plan, your coverage costs may be slightly different, but your Medicare Advantage plan must cover everything that Original Medicare covers. Medicare Advantage plans may also cover prescription drugs, depending on the plan.

What is Medicare Part D?

Medicare Part D is optional prescription drug coverage available to anyone enrolled in Part A and/or Part B. Medicare Part D Prescription Drug Plans typically cover prescription medications your doctor orders to treat your disease or condition. Although your plan may not cover all medications, plans are required to cover a certain number of medications needed to treat most illnesses and conditions. Medicare Part D may also cover commercially available vaccines your doctor may recommend that are not covered under Part B.

Each Medicare Part D plan uses a formulary, or a list of covered medications and cost information. If you take daily prescription medications, it’s a good idea to make sure they are included in the formulary of any Medicare Part D plan you are interested in.

Your out-of-pocket costs for prescription drugs covered by your Medicare Part D plan vary depending on the plan you choose. You may have to meet an annual deductible before your Medicare Part D benefits apply, and you typically pay a coinsurance or copayment amount for each covered prescription.

What prescription drugs are covered by Medicare Part B?

Medicare Part B covers certain prescription medications you get in your doctor’s office or other outpatient setting. Medications you get by injection or infusion are generally covered, for example. Medicare Part B may also cover medications used with durable medical equipment such as insulin used with an external insulin pump.

Medicare Part B may also cover oral cancer medications, transplant and immunosuppressive drugs, and certain medications to treat end-stage renal disease (ESRD). It may also cover injectable drugs you administer yourself at home, such as clotting factor and osteoporosis drugs.

You usually pay 20% of the allowable charge for covered medications after you meet your Medicare Part B deductible.

How does Medicare Part B compare to Medicare Part D?

The following chart may help you understand the difference in coverage of prescription medications between Medicare Part B and Medicare Part D:

 

Medicare Part B Medicare Part D
Eligibility Age 65 or over with qualifying work history. You might qualify before age 65 if you are disabled or have ESRD Anyone enrolled in Part A and/or Part B
Vaccines Flu, pneumococcal, hepatitis B, and possibly others depending on your condition All commercially available vaccines not covered by Part B
Insulin Only if used with an insulin pump Only if NOT used with a pump
Oral medications Generally limited to:

·       Oral cancer medications

·       Oral medications to treat nausea as a result of cancer treatment

·       Oral immunosuppressive medications

·       Certain transplant drugs

·       ESRD drugs

Covers most oral medications to treat your condition; check your plan’s formulary for specifics
Injections and infusions Typically covered if medically necessary to treat your condition May cover medically necessary injections and infusions not covered by Part B
Costs 20% of allowable charges after Part B deductible is met Copayment or coinsurance percentage depending on the plan. You may have to pay an annual deductible

 

Generally Medicare Part B doesn’t cover oral medications you take at home, except in certain situations. Medicare Part D Prescription Drug Plans, on the other hand, generally cover most medically necessary oral medications your doctor prescribes. If there is any doubt about a particular medication your doctor prescribes, you can check your plan formulary to see if it’s covered.

To look for a Medicare Part D Prescription Drug Plan in your area, enter your zip code on this page.

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