Does Medicare Part A and B Cover Prescriptions?
Medicare Part A and Part B do not generally cover routine prescriptions you pick up at a pharmacy. Part A may cover drugs you receive as part of a covered inpatient hospital or skilled nursing facility stay. Part B covers only a limited number of drugs under specific conditions. For most regular prescription drug coverage, people with Original Medicare usually add Medicare Part D.
Does Original Medicare cover prescriptions?
Original Medicare means Medicare Part A and Part B. It provides hospital and medical coverage, but it is not the same as Medicare prescription drug coverage.
In most cases, Part A and Part B do not cover the prescriptions you take at home and fill through a retail or mail-order pharmacy. Those drugs are usually handled through Medicare Part D, if you choose to enroll in drug coverage.
What prescriptions can Medicare Part A cover?
Medicare Part A is hospital insurance. It may cover drugs you receive as part of your treatment during a covered inpatient stay, such as in a hospital or skilled nursing facility.
This does not mean Part A continues to cover the same medication after you leave the facility. Prescriptions you fill after discharge are generally not covered by Part A and may need Part D coverage or another source of drug coverage.
What prescriptions can Medicare Part B cover?
Medicare Part B is medical insurance. It covers a limited number of prescription drugs under certain conditions.
Part B drug coverage often applies to drugs you usually would not give yourself, such as certain medications given in a doctor’s office or hospital outpatient setting. It may also apply to certain dialysis-related drugs, some transplant-related immunosuppressive drugs, and other specific drugs when Medicare rules are met.
If a drug is considered self-administered in an outpatient setting, Part B may not cover it. If you have Part D, your drug plan may cover it in some circumstances, but you may need to pay first and request reimbursement from the plan.
How do you get regular prescription drug coverage?
Medicare prescription drug coverage is called Part D. You can generally get it in one of two ways:
- A separate Medicare drug plan: This can be added to Original Medicare and some other Medicare plan types.
- A Medicare Advantage plan with drug coverage: Many Medicare Advantage plans include Part A, Part B, and Part D through one plan.
To join a separate Medicare drug plan, Medicare.gov states that you must have Medicare Part A and/or Part B. To join a Medicare Advantage plan, you generally must have both Part A and Part B.
What should you check before assuming a drug is covered?
Drug coverage can depend on where you receive the drug, how it is administered, and which part of Medicare is responsible for payment.
- Ask whether the drug is billed under Part A, Part B, or Part D.
- If you have, Part D, check your plan’s formulary, which is its list of covered drugs.
- Confirm whether your pharmacy is in the plan’s network.
- Ask whether the drug requires prior approval, step therapy, or another plan rule.
If you are unsure, contact Medicare, your drug plan, or the provider billing for the medication before filling an expensive prescription when possible.
Does Medigap cover prescriptions?
Medigap, also called Medicare Supplement Insurance, helps pay some out-of-pocket costs in Original Medicare. It is not the same as Part D.
Medicare.gov states that Medigap plans sold after 2005 do not include prescription drug coverage. If you have Original Medicare and want coverage for most retail prescriptions, you generally need a separate Medicare drug plan unless you have other creditable drug coverage.
From First Meeting to Medicare Enrollment
We begin by helping you understand how Medicare works and how the different pieces fit together. We walk through Original Medicare, Parts A and B, Medicare Advantage, Medicare Supplement insurance, and Part D prescription drug coverage, including how formularies, drug tiers, and plan rules can affect your costs.
We also explain dental, vision, and hearing coverage, along with other products that may help fill gaps in your healthcare plan. Depending on your needs, that may include short-term in-home healthcare coverage, hospital indemnity insurance, or coverage designed to provide additional financial support following a cancer diagnosis, heart attack, or stroke.
Once you understand the landscape, we move into the planning stage. That is when we review your doctors, hospitals, prescription drugs, current coverage, and other personal details so we can begin evaluating the Medicare plan options that fit your situation.
Official Sources
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Prescription Drug Coverage
Verifies that Part B covers a limited number of outpatient prescription drugs under certain conditions and that Part D covers many drugs Part B does not cover. -
How do drug plans work? | Medicare
Explains how Medicare drug plans work and notes that drugs received in a hospital or skilled nursing facility are generally covered by Part A as part of inpatient treatment during a covered stay. -
Drug coverage basics | Medicare
Verifies that Medicare drug coverage is obtained through Medicare-approved plans and that a separate drug plan can be added to Original Medicare. -
What's Medicare drug coverage (Part D)? | Medicare
Verifies that Medicare Part D helps pay for brand-name and generic prescription drugs and is offered to people with Medicare by Medicare-approved companies. -
Parts of Medicare | Medicare
Verifies that Original Medicare includes Part A and Part B and that Part D helps cover prescription drug costs. -
Learn what Medigap Covers | Medicare
Verifies that Medigap plans sold after 2005 do not include prescription drug coverage and that people can enroll in a separate Part D plan for drug coverage.
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