Prescription medications have allowed countless people to start managing their health problems on a daily basis. This has enabled many to live with their condition, instead of being debilitated by it, and to continue working and living in society. Recent years have seen the price of some medications climb, so finding ways to mitigate those costs has become imperative.

As a provider of services such as Medicare Prescription Drug Coverage Brooklyn NY, we know that Medicare offers a huge degree of financial relief from the terrifyingly high cost of healthcare in America today. Prescription drugs are also subject to these price increases, and over the pandemic we saw several cases of people forgoing their medication for food or rent. If you’re currently on a Medicare plan, or considering it, and need prescription medication, it might be time to consider upgrading your plan to include medication.

Here is a look at whether adding a Part D Drug Plan to your Medicare is the right move for you.

What’s Covered Under Part B Medicare Drug Plans?

One of the most common questions we’re asked about Medicare Prescription Drug Coverage Brookly NY, is whether it’s worth adding a Part D to your plan. This depends on whether your medication is already covered under Part B. Medicare Part B (Medical Insurance) covers a limited number of outpatient prescription drugs in certain conditions. It usually covers drugs you wouldn’t self-administer, like those you get at a doctor’s office or hospital outpatient setting.

Abiding by the above parameters, the following examples may help to understand whether your medication is covered under Part B.

Some Antigens

Medicare helps pay for antigens if they’re prepared by a doctor and administered by a properly instructed person under appropriate supervision.

Drugs used with an item of Durable Medical Equipment (DME)

Medicare helps pay for drugs infused with DME if they are deemed reasonable and necessary.

Injectable Osteoporosis Drugs

Women with osteoporosis who meet the criteria for the Medicare home health benefit and has a bone fracture that a doctor certifies was related to post-menopausal osteoporosis.

Erythropoiesis-Stimulating Agents

– Medicare will help pay for erythropoietin by injection if you have End-Stage Renal Disease (ESRD) or if you need the drug to treat anemia related to other conditions.

Blood Clotting Factors

If you have hemophilia, Medicare helps pay for clotting factors you administer to yourself via injection.

Injectable and Infused Drugs

Most of these are covered by Medicare when given by a licensed medical provider as they aren’t self-administered.

Oral ESRD Drugs

If the oral ESRD drugs are the same as what is available in injectable form, Medicare may help pay for it.

Intravenous and Tube Feeding (Parenteral and Enteral Nutrition)

Medicare covers certain nutrients if you can’t absorb nutrition through your intestinal tract or eat via the mouth.

Intravenous Immune Globulin (IVIG) Provided In-Home

If you have a diagnosis of primary immune deficiency disease, Medicare will help pay for IVIG. A doctor must determine that it’s medically appropriate for the IVIG to be given in your home. Part B covers the IVIG, but doesn’t pay for the other items and services related to you getting the IVIG at home.

Vaccinations (shots)

Flu shots, pneumococcal shots, Hepatitis B shots, and some other vaccines are covered by Medicare when they’re related directly to the treatment of an illness or injury.

Transplant and Immunosuppressive Drugs

If your organ transplant was covered under Medicare, then they will also cover the associated drug therapy.

What’s Covered Under Part D Medicare Drug Plans?

If your prescription medication doesn’t come under any of the above parameters, then chances are it may be covered under Part D. To mitigate high costs, plans are built to suit the different costs of medications, grouped into tiers.

The Tiers

There are typically four tiers to a Medicare Drug plan, which are usually set out as follows:

 

  • Tier 1 – offering the lowest copayment, this covers most generic prescription drugs
  • Tier 2 – offering a medium copayment, this covers preferred brand-name prescription drugs
  • Tier 3 – offering a higher copayment, this covers non-preferred brand name prescription drugs
  • Tier 4 – offering the highest copayment, this covers very high cost prescription drugs

 

Depending on your medical needs or personal preferences, one of these tiers may be more suitable to you. To learn more about Medicare Prescription Drug Coverage Brooklyn NY, feel free to contact us or view our available plans on our website. Be sure to check the formulary for whether your specific medications are covered under the plan before going ahead.