While Medicare Part D Part D, also known as the Medicare prescription drug benefit, is the part of Medicare that provides prescription drug coverage. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan. covers your prescription A prescription is an order for a health care service or drug written by a qualified health care professional. drugs in most cases, there are circumstances where your drugs are covered under either Part A Part A, also known as hospital insurance, is the part of Medicare that covers most medically necessary hospital inpatient care, skilled nursing facility (SNF) care, home health care, and hospice care. or Part B Part B, also known as medical insurance, is the part of Medicare that covers most medically necessary doctors’ services, preventive care, hospital outpatient care, durable medical equipment (DME), laboratory tests, x-rays, mental health services, and some home health care and ambulance services. .
- Part A covers the drugs you need during a Medicare-covered stay in a hospital or
skilled nursing facility (SNF)
Skilled nursing facilities (SNFs) are Medicare-approved facilities that provide short-term post-hospital extended care services.
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- Note: If you are getting SNF care that is not covered by Part A, your drugs may be covered by Part D.
- Part B covers most drugs administered by your provider See Health Care Provider. or at a dialysis Dialysis is the treatment used to artificially cleanse your blood of toxins when your kidneys no longer work. facility, but the provider or facility must buy and supply the drugs. Part B also covers some outpatient An outpatient is a patient who has not been formally admitted into the hospital as an inpatient. Most outpatient care is covered under Medicare Part B (medical insurance). prescription drugs, mainly certain oral cancer drugs (chemotherapy). Outpatient drugs previously paid for by Part B will continue to be paid for by Part B. Part D cannot pay for any of your drugs that are covered by Part B.
- Part D covers most outpatient prescription drugs (drugs you fill at a pharmacy). Check your plan’s formulary The formulary is the list of prescription drugs covered by a Part D plan or Medicare Advantage Plan. If your drug is not on the formulary, you may have to request an exception, file an appeal, or pay out of pocket. to find out whether it covers the drugs you need.
Note: There are a few drugs that can be covered by either Part B or Part D depending on the circumstances.