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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 medications. 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:
What’s the difference between Medicare Part B and D?
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.
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.
Confused by Medicare terms?
What 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.