Medicare Part B vs. Part D
Learn when to use either your Part B or Part D medical coverages for certain prescription drugs and pharmacy-related items.
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How does Medicare prescription drug coverage work?
In general, Medicare Part B covers medical care while Medicare Part D covers most prescription drugs. However, there are times when you will need to use your Part B medical coverage for certain types of prescriptions and pharmacy-related items.
What does Medicare Part B vs. Part D cover?
Part B (Medical Insurance)
Items that may be covered by Medicare Part B, and not Part D:
Need Medicare coverage?Cigna HealthcareSM has Medicare Advantage, Medicare Supplement, and Medicare Prescription Drug Plans.
What’s the difference between Medicare Part B and D?
Medicare Part B
Part B is your medical coverage. This part pays for things like doctor visits, lab tests, and home health care. Part B also covers certain medications and durable medical equipment like diabetic test strips, nebulizers, and wheelchairs.
You can get your Part B medical coverage through your former employer, through a standalone plan, or directly from Medicare. To enroll in Medicare Part D, you must already have either Medicare Part A or Part B.
You pay a Part B premium to Medicare every month.
Medicare Part D
Part D is your prescription drug coverage. Part D pays for any medications you take regularly to manage chronic conditions, for example, heart disease, high cholesterol, or asthma. It also pays for any medications you take for a short period of time, such as antibiotics.
Many retail pharmacies cannot bill a medical plan for Medicare medical prescriptions (commonly referred to as Part B drugs) or medical equipment.
If you need Part B drugs or medical equipment, ask if your pharmacy is able to bill your medical plan directly. Or, consider using these types of specialty service providers:
- Medical equipment
- Home infusion
- Home health care
- Specialty pharmacy
- Medical specialty service
- Mail-order pharmacy
Not all items that you purchase at a pharmacy are covered by your prescription drug plan (Part D). Certain health supplies or equipment may be covered by the medical part of your Medicare plan, Part B.
What prescription drugs are covered by Medicare Part B?
Medicare Part B only covers certain medications for some health conditions, while Part D offers a wider range of prescription coverage. Part B drugs are often administered by a health care provider (i.e. vaccines, injections, infusions, nebulizers, etc.), or through medical equipment at home. Examples of drugs covered under Medicare Part B include:
- Injections for osteoporosis
- Some transplant medications
- End-stage renal disease (ESRD) medications
- Flu, pneumonia, and Hepatitis B shots
Medicare Part D may cover medications that aren’t covered under Part B, and vice versa. When you choose a Medicare plan, make sure it will cover your current medications.
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The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one-hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:
(1) the Medicare Part B Deductible;
(2) any expense which You are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;
(3) any services that are not medically necessary as determined by Medicare;
(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if You were enrolled in Parts A and B of Medicare;
(5) any type of expense not a Medicare Eligible Expense except as provided previously in this policy;
(6) any deductible, Coinsurance or Co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy; or
(7) Preexisting Conditions: We will not pay for any expenses incurred for care or treatment of a Preexisting Condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if You applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy You had at least six (6) months of prior Creditable Coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If You had less than six (6) months prior Creditable Coverage, the Preexisting Conditions limitation will be reduced by the aggregate amount of Creditable Coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied.