Does Original Medicare Cover Prescriptions?
01 Oct 2023 ∙ 2 min read
Quick Overview
Original Medicare offers essential health coverage, but does it extend to prescription medications? Dive into the details of drug coverage under Medicare, the significance of Part D, and other alternatives to ensure comprehensive protection.
Understanding Original Medicare
Original Medicare, encompassing Part A Medicare (hospital insurance) and Part B (medical insurance), serves as the foundation for many retirees' health coverage. While it offers broad benefits for hospital stays, outpatient services, and preventive care, there's a crucial aspect it doesn't generally cover: prescription medications for home use.
The Role of Medicare Part D
Addressing the gap in Original Medicare, Part D Medicare offers an opportunity for beneficiaries to get coverage for their prescription drugs. Enrolling separately, Part D plans are offered by private insurance companies approved by CMS (Centers for Medicare & Medicaid Services). This plan covers both brand-name and generic drugs, subject to certain formulary lists.
Exploring Medicare Advantage Plans
Another route for prescription coverage is through a Medicare Advantage Plan (also known as Part C Medicare). These plans, provided by private insurers like Aetna, Humana, and Blue Cross Blue Shield, often combine Original Medicare services with additional benefits, including drug coverage. Depending on the plan type, be it HMO, PPO, PFFS, or POS, the coverage specifics and network rules may differ.
Supplemental Insurance: Beyond Basic Coverage
For those looking for extra protection, Supplemental Insurance (often termed Medigap) can bridge the coverage gaps left by Original Medicare. While Medigap doesn’t directly cover prescription drugs, pairing it with a standalone Part D plan ensures comprehensive health and medication coverage. Top providers like Cigna and United Healthcare offer these supplemental options.
Why Seek Help Navigating Medicare Options?
With multiple pathways and myriad plan options available, determining the optimal Medicare plan can be challenging. Seeking expert guidance can demystify the intricacies, clarify Medicare Eligibility criteria, and help beneficiaries select the right fit for their unique health needs.