Original Medicare technically does not cover prescription medications. That is why most Medicare enrollees also need a Medicare Part D Prescription Drug plan to accompany it. There are exceptions for medication coverage with Part A and Part B, though, which is what Original Medicare is composed of.
Medicare Part A
Medicare Part A coverage ranges from inpatient hospital care to hospice care. Inpatient hospital care is defined as being officially admitted into the hospital by a doctor. For each benefit period, you are covered for 90 days, plus 60 lifetime reserve days. Medicare Part A covers the medications you need administered during your inpatient hospital stay. You are also covered for 90 lifetime days in a Medicare-certified psychiatric hospital.
Medicare Part A also covers SNF, also called skilled nursing facility care. They cover things such as room, board, administration of medications, tube feeding, and wound care. So, in essence, Medicare Part A covers necessary medications needed at the time. This is different from maintenance medications, which are covered under Medicare Part D.
Medicare Part B
Medicare Part B covers outpatient medical coverage, such as doctor visits, home health services, ambulatory services, and preventative services, just to name a few. You can check your Original Medicare plan to discover what all your Medicare Plan B services cover. Medicare Part B also covers Durable Medical Equipment (DME), which is defined as equipment that serves a medical purpose, is able to withstand repeated use, and is appropriate for use in the home. DME is able to be rented or purchased from a Medicare-approved facility if your provider deems it necessary. Medicare Part B covers medications that are necessary to be used with your Durable Medical Equipment, like a nebulizer or pump, if it is deemed medically necessary.
Medicare Part B covers a lot of outpatient medical services, and also covers certain prescription medications. It covers immunosuppressant drugs that are prepared by the doctor and given by a designated individual (possibly you, the patient,) under appropriate supervision, some anti-cancer and anti-nausea.
Medicare Part B will also cover injectable osteoporosis drugs for women who meet the home health benefit requirements and have a bone fracture that is certified by a doctor to be related to postmenopausal osteoporosis. Your physician must certify that you are unable to give yourself the injection. Medicare Part B will not allow your home nurse or home aide to provide this injection unless your family members are unable or unwilling to provide you with this injection.
Medicare will help pay for erythropoietin via injection if you are diagnosed with ESRD or End-Stage Renal Disease, or if you need this medication due to anemia or certain other conditions. Medicare Part B helps pay for some oral ESRD drugs as well.
If you are diagnosed with hemophilia, then Medicare will help cover blood-clotting medications you administer yourself via injection.
Medicare Part B will also help cover infused and injectable drugs because they are given by the licensed medical doctors and not given to you by yourself.
Need Prescription Drug Coverage?
While Original Medicare does not have a formulary that lists each drug it covers due to it not having a defined drug plan, it does cover certain medications in certain circumstances. But, to get even better coverage for your prescriptions, we recommend that you get a Medicare Part D prescription drug plan.
To learn more about how to get the best prescription drug coverage, contact Cornerstone Senior Advisors today!