Medicare Part B does not cover most prescription drugs

Medicare Part B covers doctor visits, outpatient care, lab work, and medical equipment — but it does not pay for prescription medications you take at home. If you need regular prescriptions, you will need a separate plan to cover them.

The only medications Part B covers are those given to you in a doctor's office or hospital outpatient setting — for example, an injection your rheumatologist administers during an appointment, or chemotherapy at an infusion center. Once you leave with a prescription to fill at a pharmacy, Part B stops paying.

This is why most people on Original Medicare add Part D (prescription drug coverage) or choose a Medicare Advantage plan (Part C), which usually includes drug coverage built in. Without one of these, you pay the full pharmacy price yourself.

Key Takeaways

  • Part B covers medications given to you during a medical visit, but not pills or liquids you take home from the pharmacy.
  • Part D is the standalone prescription drug plan you add to Original Medicare if you want pharmacy coverage.
  • Medicare Advantage plans (Part C) typically include prescription drug coverage as part of the plan, so you do not add Part D separately.
  • If you do not have any drug coverage and cannot afford medications, you can look into patient information programs run by drug manufacturers or community health centers.

The difference between Part B coverage and Part D coverage

Part B is designed to cover the medical care itself — the doctor's time, the facility, the equipment. When a medication is part of that care (injected or infused during your visit), Part B pays for it. You typically pay a copay or coinsurance, just as you would for any other Part B service.

Part D is a separate insurance product that covers medications you pick up at a pharmacy or have delivered to your home. It has its own monthly premium, deductible, and copays. Part D plans are offered by private insurance companies, and the coverage and cost vary widely from plan to plan.

If you have Original Medicare (Part A and Part B) without Part D or a Medicare Advantage plan, you have no insurance coverage for take-home medications. You will pay the pharmacy's full price, which can be hundreds of dollars per month for common drugs.

When Part B does cover medications

Part B covers drugs that are given to you as part of a medical procedure or treatment in a medical setting. This includes:

  • Injections or infusions given in a doctor's office, hospital outpatient department, or ambulatory surgery center
  • Medications included in dialysis treatment
  • Certain drugs given during chemotherapy or radiation therapy
  • Immunosuppressant drugs for the first year after an organ transplant (after that, Part D covers them)
  • Blood clotting factors for people with hemophilia

In these cases, the provider bills Medicare Part B directly, and you pay your usual Part B copay or coinsurance (typically 20 percent of the approved amount after you meet your deductible).

What happens if you do not have Part D or Medicare Advantage

If you are on Original Medicare without any prescription drug coverage, you are responsible for the full cost of medications at the pharmacy. This can mean paying $50 to $500 or more per month, depending on what you take.

You can still add Part D coverage during the annual enrollment period (October 15 to December 7 each year) or if you have a may have access to life event, such as losing other drug coverage. If you miss the enrollment important date and do not have a reason that qualifies you for a special enrollment period, you may face a late enrollment penalty that increases your Part D premium permanently.

If you cannot afford your medications right now, some options include asking your doctor about generic versions, looking into patient information programs run by the drug manufacturer, or visiting a community health center that offers sliding-scale fees based on income.

How to add Part D to Original Medicare

Part D is sold by private insurance companies, and you choose which plan to enroll in during the annual enrollment period. You can compare plans on Medicare.gov, where you can enter your medications and see which plans cover them and at what cost.

Plans vary significantly in their monthly premium, deductible, and copays. A plan that is cheapest for one person may be expensive for another, depending on which drugs they take. Spending 15 minutes comparing plans on Medicare.gov can save you hundreds of dollars per year.

Once you enroll, your coverage starts on January 1 (if you enroll by December 7). You can change plans once per year during the annual enrollment period, so if your needs change or a better plan becomes available, you are not locked in.

Medicare Advantage plans and prescription drug coverage

If you choose a Medicare Advantage plan (Part C) instead of Original Medicare, most plans include prescription drug coverage. You do not add Part D separately — the drug coverage is part of the plan you choose.

Like Part D plans, Medicare Advantage drug coverage varies by plan. Some plans have low copays for common drugs; others have higher copays or require you to use specific pharmacies. You can compare the drug coverage in each plan on Medicare.gov before you enroll.

One advantage of Medicare Advantage is that you have one plan to manage instead of Original Medicare plus Part D. One disadvantage is that you are usually limited to using doctors and hospitals in the plan's network, whereas Original Medicare lets you see any provider who accepts Medicare.

Frequently Asked Questions

Does Medicare Part B cover insulin?

No. If you take insulin at home, you need Part D or a Medicare Advantage plan to cover it. If you receive insulin as part of a hospital stay or outpatient procedure, Part B covers it. Some people may have access to for the Part B insulin copay cap (a maximum of $35 per month for covered insulin), but this applies only to insulin given during a medical visit, not pharmacy insulin.

What if my doctor injects a medication during my visit — does Part B pay for it?

Yes. If the medication is administered to you in the doctor's office or outpatient facility as part of your treatment, Part B covers it. You pay your usual Part B copay or coinsurance. If the doctor gives you a prescription to take home, that is not covered by Part B.

Can I use Part D at any pharmacy?

Most Part D plans work at major pharmacy chains like CVS, Walgreens, and Walmart, as well as mail-order pharmacies. Some plans have preferred pharmacies where your copay is lower. Check your plan's pharmacy network before you enroll, especially if you have a pharmacy you prefer to use.

What is the Part D coverage gap, and how does it work?

The coverage gap (sometimes called the "donut hole") is a range of drug costs where you pay a higher share of the cost. Once your total drug costs reach a certain amount, you enter the gap and pay more out of pocket until your costs reach a second threshold, at which point catastrophic coverage kicks in and you pay less again. The exact amounts change each year, and not all plans have a gap. Your plan documents will explain how it works for your specific plan.

If I have both Medicare and employer health insurance, do I still need Part D?

It depends on your employer plan. If your employer plan covers prescriptions as well as or better than Part D would, you may not need Part D. However, if you drop Part D and later lose your employer coverage, you may face a late enrollment penalty when you try to add Part D. Talk to your employer's benefits administrator before you decide.