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Most people who are familiar with Medicare think of Part D when asked about prescription drug coverage. But did you know that Medicare Part B covers some medications, too? If you’ve recently been diagnosed with a health condition, you may be wondering which part of Medicare will help you get the most affordable treatment.
What is Medicare Part B?
This part of Medicare covers outpatient medical services, durable medical equipment, such as insulin pumps, and preventive healthcare services.
- Doctor’s visits, including preventive services and annual physical exams
- Clinical research trials
- Ambulance services
- Durable medical equipment
- Outpatient mental health services
- Some (but not most) outpatient prescription drugs
- Some vaccinations
RELATED: Does Medicare cover flu shots?
Does Medicare Part B cover prescriptions?
Medicare Part B does cover some prescriptions. Insulin used in external insulin pumps (if medically necessary), some drugs prescribed during dialysis are covered, and some chemotherapy drugs and outpatient oral cancer drugs.
Other drugs covered by Part B include those administered by a healthcare professional in a doctor’s office or another medical facility. These include vaccines and other injectable drugs and drugs that are administered through a feeding tube.
List of drugs covered by Medicare Part B
Certain drugs are covered by Medicare Part B under limited conditions, usually in a doctor’s office or hospital setting. Medicare Part B drugs include:
- Drugs used in conjunction with durable medical equipment such as infusion pumps or nebulizers
- Antigens that are prepared by your doctor
- Injectable osteoporosis drugs
- Erythropoiesis-stimulating agents for those with end-stage renal disease
- Blood clotting factors
- Injectable and infused drugs
- Oral end-stage renal disease (ESRD) drugs including Parsabiv and Sensipar
- Parenteral (intravenous) and enteral (tube) nutrients
- Intravenous immune globulin (IVIG)
- Vaccinations (flu, pneumococcal, Hepatitis B, and others)
- Immunosuppressant drugs related to organ transplant
- Oral cancer drugs
- Oral anti-nausea drugs
- Self-administered drugs in a hospital setting
How much does Medicare Part B cost?
The standard Medicare Part B premium for 2024 is $174.70, but this premium may increase if your income falls above a certain level. The Social Security Administration uses the income reported on your most recent federal tax return to determine whether you will be responsible for paying any additional premium during your enrollment. Premiums may increase depending on income, however, there are no income limits to being able to receive Medicare benefits.
What is the difference between Part B and Part D?
Although both cover medications, there are a few key differences between drug coverage under Medicare Part B and Medicare Part D drug coverage. The medications covered under Medicare Part B are drugs that would typically be administered by a healthcare provider at a hospital or doctor’s office. Medicare Part D coverage provides additional drug coverage to lower out-of-pocket costs on prescription medications you take regularly at home.
Medicare prescription drug coverage: Part B vs. Part D |
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|---|---|---|
| Medicare Part B | Medicare Part D | |
| Eligibility | If you are eligible to enroll in Medicare Part A (65+ years old, on social security disability for 2 years, end-stage renal disease, or ALS), you are eligible to enroll in Part B. | You must be enrolled in Medicare Part A and/or Part B to enroll in Medicare Part D. |
| Enrollment | Initial enrollment period begins 3 months before your 65th birthday and ends 3 months after the month of your birthday (for a total period of 7 months).
If you miss the initial enrollment period, you may have to pay a monthly late enrollment penalty for the entire duration of time that you are enrolled in Part B, unless you have low income or creditable coverage. Thereafter, the open enrollment period is between Jan. 1-March 31 annually. |
Initial enrollment period begins 3 months before your 65th birthday and ends 3 months after the month of your birthday (for a total period of 7 months).
If you miss the initial enrollment period, you may have to pay a monthly late enrollment penalty for the entire duration of time that you are enrolled in Part D, unless you have low income or creditable coverage. Thereafter, the open enrollment period is between Oct. 15-Dec. 7 annually. |
| Special Enrollment Periods also apply | ||
| Costs* |
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| Covered drugs |
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Medicare Part D covers FDA-approved prescription drugs that are regularly taken at home. See your plan’s formulary to find out which drugs are covered. |
| Other considerations | Medicare Part B generally does not cover drugs that are administered in a hospital emergency department or hospital inpatient unit. | By law, Medicare Part D cannot pay for any medications that Part A or Part B covers. The following drugs also aren’t covered by Part D:
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*These costs are reduced or eliminated if a person is low income and enrolls in a Medicare Savings Program, or MSP (for Part B) or Extra Help (for Part D).
Bottom line: You may need Medicare Part B and Part D
You may not foresee needing the type of drugs that Medicare Part B covers; however, if you don’t enroll in Part B, you’ll also be missing out on coverage for doctor’s visits, ambulance services, and durable medical equipment.
If you think you need Medicare Part B and Part D coverage, you can consider a Medicare Advantage plan (also known as Part C) instead of Original Medicare (Part A and B). Medicare Advantage includes Part A (inpatient hospital insurance), Part B (outpatient medical insurance), and usually Part D (drug coverage). However, Medicare Advantage will change the way your Medicare is administered including networks, prior approval, and other implications.
RELATED: Original Medicare vs. Medicare Advantage
For even more coverage with Original Medicare, consider a Medicare supplement plan like Medigap. Eligible Medicare beneficiaries can also apply for low-income subsidies like Medicare Savings Programs or Medicare Extra Help to lower prescription drug costs and other Medicare-related expenses.
Sources
- Prescription drugs (outpatient), medicare.gov
- Special Enrollment Periods, medicare.gov
