Prescription medications have been some of the most amazing innovations in medical science over the last 100 years. Prescription drugs can treat everything from heart disease to cancer, and many people take prescription drugs as a preventative measure to enjoy a better quality of life.
In fact, life expectancy is now close to 80 years old in the United States, up nearly 10 years since 1960 when men and women had a life expectancy of about 70 years old. While healthier living and better working conditions have contributed to this increase in overall life expectancy, prescription medications and the research behind them have played a big part as well.
Does Medicare cover prescription drugs?
Prescription drugs may be an occasional treatment for acute conditions, but many seniors take prescription medications daily for chronic conditions and to prevent disease. While some prescriptions can be purchased at retail pharmacy locations, others need to be administered in a clinical setting like a doctor’s office or a lab. In the latter case, drugs may need to be injected or infused.
Original Medicare benefits cover prescription drugs under Medicare Part D in most cases. This is optional coverage, and you can still carry Medicare Part A, the inpatient benefit, and Medicare Part B, the outpatient benefit, without carrying Medicare Part D.
If you add Part D to your Medicare coverage, the list of drugs included can be found in your plan’s formulary. This list not only provides the names of all of the prescription medications covered by your plan, but it may also list additional information specific to each drug, including information about quantity limitations.
How much does Medicare Part D cost?
Unlike Medicare Part A, Medicare Part D doesn’t have a fixed cost, but it does have cost maximums in regard to Medicare’s premiums. Prescription drug coverage through Medicare is purchased from private insurers, and costs and benefits may vary.
Your monthly Part D premium will depend on the plan you choose and your income. Although your plan premium is determined by your provider and the options included in your plan, Medicare may also charge a premium based on your income. The higher your income, the more you will be required to spend.
In 2022, Medicare recipients who are single or married filing separately and have an income of $91,000 per year or less will simply pay their plan premium. Medicare recipients who file jointly can earn up to $182,000 per year combined and still pay the plan premium only.
If, however, you make above $91,000 as a single or married-filing-separately recipient of Medicare, your costs go up. According to the Centers for Medicare & Medicaid Services (CMS), earners who bring home $409,000 or more as a single filer, or $750,000 or more as a joint filer, will be required to pay $77.90 per month in addition to the Part D plan premium. There are different amounts for various tax brackets in between, but if you earn over $91,000 as a single filer or over $182,000 as a joint filer, you will be required to pay extra on top of your plan premium.
How much does Medicare Part D cost for hospital prescriptions?
Although Medicare benefits under Part D cover prescriptions purchased from retail pharmacies, Part D does not cover medications administered while formally admitted into a hospital or skilled nursing facility. In such situations, Medicare Part A may cover treatment costs, including medication support, while admitted. Part A does have limitations regarding the length of care, but while you are admitted, your medications provided by the facility should be covered by Medicare Part A.
Does Medicare cover over-the-counter medications?
While the Medicare benefits found in Part D coverage are very beneficial, it should be noted that Medicare does not cover over-the-counter (OTC) medicines, nor does Original Medicare offer any type of reimbursement for the purchase of OTC medicines. If you purchase any type of OTC medications, you are responsible for all costs. Some Medicare Advantage plans may include OTC allowances or discounts. If this is an option, benefits are usually supplied in the form of coupons or reimbursements as opposed to outright coverage.
How much does Medicare Advantage with prescription drug coverage cost?
Medicare Advantage plans are an alternative to Original Medicare. These plans include the same Part A and Part B benefits found in Original Medicare, but MA plans may include additional benefits as well, including prescription drug coverage.
Each plan is issued by a private insurer, so your coverage options, costs, and drug formularies can vary. Where you live, the plan you choose, the benefits you need, and the amount of medication you require may affect your overall costs. Compare plans carefully before enrolling.
Talk to Your Doctor
Before deciding on any type of Part D coverage or making changes to your prescription drug coverage, you may want to speak with your doctor. It can be tempting to seek out a low-cost option to reduce financial stress over the price of certain medications, but you should never stop or start a prescription without first talking to your physician.
Additionally, your doctor may be able to find alternatives if your current prescriptions are not covered. In any case, avoid basing your decisions on cost, and instead, focus on ensuring your health is protected.