Medicare Supplement plans do not cover prescription drugs — that is what Medicare Part D does

If you take Eliquis (apixaban), a blood thinner used to prevent stroke and blood clots, your coverage for it depends on which part of Medicare you have. Medicare Supplement insurance (also called Medigap) covers the gaps in hospital and doctor visits that Original Medicare leaves behind — copays, coinsurance, and deductibles. It does not cover medications at all.

Eliquis coverage comes through Medicare Part D, which is prescription drug coverage you add to Original Medicare, or through the drug benefit built into Medicare Advantage plans. If you have a Supplement plan and Original Medicare, you must have Part D enrolled separately to cover Eliquis and other medications.

This matters because many people assume their Supplement plan covers everything Medicare does not. It does not. A Supplement plan will pay your share of a doctor visit or hospital stay, but it will not touch a pharmacy bill.

Key Takeaways

  • Medicare Supplement plans cover copays and coinsurance for hospital and doctor visits, but zero prescription drugs including Eliquis.
  • Eliquis coverage comes through Medicare Part D (if you have Original Medicare) or through a Medicare Advantage plan's drug benefit.
  • If you have a Supplement plan and Original Medicare, you must enroll in Part D during the right window or face a late penalty on your premiums.
  • Eliquis costs and coverage vary by which Part D plan you choose, because each plan has its own formulary and cost-sharing structure.
  • You can switch Part D plans every year during the Annual Enrollment Period (October 15 to December 7) to find better coverage or lower costs for Eliquis.

How Part D covers Eliquis and what you will pay

When you enroll in a Part D plan, the plan publishes a formulary — a list of drugs it covers and how much you pay for each one. Eliquis appears on most Part D formularies, but the tier (cost level) varies. Some plans put it on a lower tier with a smaller copay; others place it on a higher tier where you pay more.

Your out-of-pocket cost for Eliquis typically follows this path through the year: you pay a copay or coinsurance for each fill until you reach your deductible (if your plan has one), then you continue paying your share until your total out-of-pocket spending hits the plan's threshold. After that, you enter the coverage gap (sometimes called the "donut hole"), where you pay a larger percentage of the drug cost. Once your total spending reaches the catastrophic threshold, the plan covers most of the cost and you pay a small copay.

The exact amounts depend on your specific Part D plan. Two people on Eliquis can pay very different amounts depending on which plan they chose. This is why comparing plans during open enrollment matters — a plan with a lower monthly premium might have a higher copay for Eliquis, and vice versa.

What happens if you have a Medicare Advantage plan instead

If you chose a Medicare Advantage plan (Part C) instead of Original Medicare plus Supplement, your drug coverage is built in. Medicare Advantage plans must cover at least as many drugs as Part D does, but the copays and formularies differ from plan to plan.

Medicare Advantage plans also have networks — you usually must use doctors and pharmacies in the plan's network, or pay more. Some Medicare Advantage plans cover mail-order pharmacy fills at a lower cost than retail pharmacies, which can matter for a medication like Eliquis that you take every day.

You cannot have both a Medicare Advantage plan and a Medicare Supplement plan at the same time. If you have Advantage and want to switch to Original Medicare plus Supplement, you have limited windows to do so without medical underwriting.

Switching Part D plans if Eliquis costs too much

If your current Part D plan charges too much for Eliquis or does not cover it at all, you can switch plans during the Annual Enrollment Period, which runs from October 15 to December 7 each year. The new coverage starts January 1.

Before you switch, use the Medicare Plan Finder tool on Medicare.gov to compare how much each plan charges for Eliquis at your local pharmacy. Enter the drug name, your pharmacy, and your current plans to see side-by-side costs. Some plans offer $0 copays for certain blood thinners as a way to attract people with heart or clot conditions.

If you miss the Annual Enrollment Period, you can still switch if you have a may have access to life event — moving to a new state, losing other insurance, or a change in your income. You have 60 days from the event to make the change.

What to do if you do not have Part D yet

If you have Original Medicare and a Supplement plan but never enrolled in Part D, you can still do so during the Annual Enrollment Period. However, if you waited longer than 63 days after your Original Medicare started, Medicare will charge you a late enrollment penalty — a permanent increase to your Part D premium for as long as you have Part D coverage.

The penalty is small (roughly 1% of the national average Part D premium per month of delay), but it adds up over years. If you are already taking Eliquis without Part D coverage, you are paying the full retail price out of pocket. Enrolling in Part D, even with a penalty, is usually cheaper than paying retail.

To enroll in Part D outside the Annual Enrollment Period, you will need to document a may have access to life event or use the General Enrollment Period (January 1 to March 31 each year), though the penalty still applies if you enroll late.

Manufacturer discounts and patient information programs

If your Part D plan's copay for Eliquis is still high, check whether Bristol Myers Squibb (the manufacturer) offers a copay card or patient information program. These programs can reduce your out-of-pocket cost, though they have income limits and other restrictions.

Some programs cover the copay entirely for people who meet income thresholds. Others cap your copay at a set amount per month. You can find these programs on the manufacturer's website or ask your pharmacist whether you might be may be able to access.

Copay information does not count toward your Part D out-of-pocket spending threshold, so it does not help you reach catastrophic coverage faster — but it does lower what you pay at the pharmacy right now.

Frequently Asked Questions

Will my Medicare Supplement plan pay for Eliquis if my Part D plan does not cover it?

No. Supplement plans do not cover any prescription drugs, even if Part D does not. If a Part D plan does not cover Eliquis, you would need to switch to a different Part D plan that does, or pay the full retail price yourself.

Can I use a Supplement plan instead of Part D to save money on Eliquis?

No. Supplement plans have no drug benefit at all. You must have Part D (or Medicare Advantage) to get any insurance coverage for Eliquis. Without it, you pay the full pharmacy price.

What if I switch from a Supplement plan to Medicare Advantage — will my Eliquis coverage change?

Yes. Medicare Advantage plans have their own drug formularies and copays, which may be higher or lower than your Part D plan. You should compare Eliquis costs in the Advantage plan before you switch, because you cannot go back to a Supplement plan without medical underwriting (in most states).

Do all Part D plans cover Eliquis?

Most do, but not all. Some plans may require prior authorization (approval from the plan before you fill it) or may place it on a higher-cost tier. Always check the plan's formulary or call the plan before you enroll to confirm Eliquis is covered and at what cost.

Can I get Eliquis through a mail-order pharmacy to save money?

It depends on your Part D plan. Some plans offer lower copays for mail-order fills, especially for maintenance medications you take long-term. Check your plan's pharmacy network or call customer service to compare mail-order versus retail copays for Eliquis.