Does Medicare Cover Prescriptions?

Original Medicare (Medicare Part A and Part B) generally does not cover prescription drugs. If you’re enrolled in Original Medicare and want Medicare prescription drug coverage, there are two options you can consider.

You can switch from Original Medicare to a Medicare Advantage plan (Medicare Part C) that offers prescription drug coverage. Or you can keep your Original Medicare coverage and enroll in a Medicare Part D prescription drug plan.

Woman smiles as doctor gives prescription

Many Medicare Advantage plans may cover prescriptions

Medicare Advantage is an alternative to Original Medicare that provides the same hospital and medical benefits as Medicare Part A and Part B. In addition to those benefits, many Medicare Advantage plans cover prescription drugs.

Some Medicare Advantage plans may also offer:

Generally, you have the option to enroll in a Medicare Advantage plan if you:

  • Are enrolled in both Medicare Part A and Part B
  • Live in an area where a Medicare Advantage plan is available
  • Do not have end stage renal disease (ESRD)

Medicare Advantage prescription drug (MAPD) plans

A Medicare Advantage plan that offers prescription drug coverage may also be known as a Medicare Advantage prescription drug (MAPD) plan.

How your MAPD plan works depends on the type of Medicare Advantage plan you’re enrolled in. Generally, Medicare Advantage plans fall into one of the following categories:

  • Medicare Preferred Provider Organization (PPO) plans
    Most Medicare PPO plans cover prescription drugs, but they aren’t required to. With a PPO plan, you generally pay less for care and for prescriptions if you stay within your plan’s network of providers and pharmacies.

  • Medicare Health Maintenance Organization (HMO) plans
    Most Medicare HMO plans cover prescription drugs, but they aren’t required to. If you go to a pharmacy outside of your plan’s network, your Medicare Advantage plan generally will not cover the cost of your prescriptions. Network pharmacies and costs will vary based on your plan.

  • Medicare Private-Fee-For-Service (PFFS) plans
    Some, but not all, Medicare PFFS plans cover prescription drugs. PFFS plans permit you to go to any provider in the U.S. that accepts Medicare. If your PFFS plan provider has a network of doctors, specialists, hospitals and pharmacies, you will typically pay less if you stay within the network.

  • Medicare Medical Savings Account (MSA) plans
    Medicare MSA plans do not cover prescription drugs. These high-deductible Medicare plans deposit money into a health savings account, which you can use to pay for health care services before you meet your plan deductible. If you have a Medicare MSA plan, you also have the option to enroll in a Medicare Part D plan.

Medicare Part D prescription drug coverage

A Medicare Part D plan is designed to cover many prescription drug costs. Part D plans are sold by private insurance companies, so the cost and availability of plans can vary based on your location. A standalone Part D plan can be used alongside Original Medicare or with a Medicare Advantage plan that doesn’t offer drug coverage.

Medicare Part D prescription drug plans each have a drug formulary, which is a list of what drugs the plan covers and how much those drugs cost based on which “tier” the drug is classified into.

Learn more about some of the costs associated with Medicare Part D plans.

Find Medicare prescription drug coverage

A licensed insurance agent can help you find a Medicare Advantage in your area that offers prescription drug coverage. They can also help you enroll in a plan that works for you.

Speak with a licensed insurance agent today by calling TTY Users: 711 24 hours a day, 7 days a week.

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MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.