Does Medicare Cover Prescription Drugs?
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Medicare does cover prescription drugs. Which drugs and how they’re covered depend on your plan choices.
People with Original Medicare buy prescription drug coverage through a stand-alone Medicare Part D plan.
People with Medicare Advantage generally get prescription drug coverage through their Medicare Advantage plan.
Certain outpatient prescription drugs administered in medical offices or hospitals might be covered by Medicare Part B, instead.
Over 80% of Medicare beneficiaries have outpatient prescription drug coverage, according to data from the Centers for Medicare & Medicaid Services (CMS). Everyone with Medicare can get prescription drug coverage, but the specific method varies depending on whether you have Original Medicare or Medicare Advantage.
People with Original Medicare (Part A and/or Part B) get prescription drug coverage by enrolling in a stand-alone Medicare Part D plan sold by a private insurance company.
People with Medicare Advantage generally have prescription drug coverage through the Medicare Advantage plan, so they can’t enroll in a separate Part D plan.
» MORE: Medicare vs. Medicare Advantage
In either case, plans’ drug formularies, out-of-pocket costs and pharmacy networks can differ significantly, so it’s important to compare options with your personal situation in mind.
Here’s what you should know about how Medicare covers prescription drugs.
Still deciding on the right carrier? Compare Medicare Part D Plans
What Medicare Part D plans cover
Medicare sets certain rules for how prescription drug coverage works, but individual insurance companies and plans determine what specific drugs they cover and how. The list of a plan’s covered drugs is called a formulary. It’s crucial to check a plan’s formulary before you enroll.
Formularies are generally organized into tiers with different copays, coinsurance and/or deductibles according to the tier. Check where your drugs fall on the formulary to see what you’d owe for your prescriptions. You should also check each plan for restrictions on drug coverage, such as requirements that certain drugs be approved in advance by the insurer.
If your plan doesn’t cover a needed drug, it’s possible for you and/or your health care provider to request an exception. If you or your provider can demonstrate that it’s medically necessary, the plan might cover the drug or bill you as if the drug were on a less expensive formulary tier.
Does Medicare Part B pay for prescription drugs?
Most outpatient prescription drugs are covered by Medicare Part D. But Medicare Part B, which covers outpatient (non-hospital) medical care, covers certain outpatient drugs you don’t administer yourself, such as infusions you get in a doctor’s office or in an outpatient department in a hospital.
What you’ll pay for prescriptions
Premiums
Most stand-alone Medicare Part D plans have premiums. Part D plans have an average total monthly premium of $55.50 in 2024, according to CMS.
Medicare Advantage plans with prescription drug coverage include the cost of that coverage in the plan’s premium — you don’t pay separately for Part D benefits.
With either kind of coverage, people with very high income might owe an additional amount known as an income-related monthly adjustment amount (IRMAA).
Out-of-pocket costs
In addition to any premiums, you might also pay out-of-pocket costs such as copays, coinsurance and deductibles. These costs vary depending on the plan, drug and pharmacy where you fill the prescription.
You can enter your information on Medicare.gov to compare what different plans would cost for your specific drugs and pharmacies.
Compare Medicare Part D companies
Get more information below about some of the major Medicare Part D companies. These insurers offer plans in most states, but specifics may vary depending on your location.
Still deciding on the right carrier? Compare Medicare Part D Plans
