What is the difference between Part B and Part D drug coverage?

Asked by: Jayne Weimann  |  Last update: December 24, 2023
Score: 4.4/5 (15 votes)

Medicare Part D pays for most at-home medications, while Medicare Part B generally pays for drugs that a person receives at a doctor's office, hospital, or infusion center. Part B also pays for additional services, such as doctor's visits and some medical procedures.

What is the difference between Medicare Part B and Part D drugs?

In general, Medicare Part B covers medical care while Medicare Part D covers most prescription drugs. However, there are times when you will need to use your Part B medical coverage for certain types of prescriptions and pharmacy-related items.

Can a drug be covered under both Part B and Part D?

Most drugs are covered under Part D, but there are some drugs that can be covered under both Part B or Part D depending on what the drug is used for and how it is administered.

Can you have Medicare Part D without Part B?

You must be enrolled in Medicare Part A and/or Part B to enroll in Part D. Medicare drug coverage is only available through private plans. If you have Medicare Part A and/or Part B and you do not have other drug coverage (creditable coverage), you should enroll in a Part D plan.

What does Medicare Part D cover?

Medicare Part D helps cover the cost of prescription drugs. Part D is optional and only provided through private insurance companies approved by the federal government. However, Part D is offered to everyone who qualifies for Medicare.

2023 Medicare Costs Comparison | Advantage vs Supplement

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Does everyone on Medicare have to pay for Part D?

Medicare Part D is voluntary. In some circumstances you may not need it if you are receiving “creditable” prescription drug coverage elsewhere such as an employer or union, retiree benefits, COBRA or the Veterans Affairs health program — all of which must by law tell you whether it is creditable.

What is the out of pocket maximum for Medicare Part D?

Medicare Part D plans don't have hard out-of-pocket maximums. However, in all Part D plans, you enter what's called the catastrophic coverage phase after you hit $7,400 in out-of-pocket costs for covered drugs.

Can I get Medicare Part D alone?

There are 2 different ways you can get prescription drug coverage. You could enroll in a stand-alone Medicare Part D plan , or you could get drug coverage as part of a Medicare Advantage plan . There are also a few different ways you can enroll: Use Medicare's plan finder tool to enroll online.

Does Part D penalty go away when you turn 65?

If you are enrolled in Medicare because of a disability and currently pay a premium penalty, once you turn 65 you will no longer have to pay the penalty. How do you calculate your premium penalty? Let's say you delayed enrollment in Part D for seven months (and you do not meet any of the exceptions listed above).

What happens if you don't take Part D Medicare?

Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($32.74 in 2023) times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.

What does Part B not cover?

Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Other services not covered by Medicare Parts A and B include: Routine foot care. Cosmetic surgery.

What drugs are excluded from Part D plans?

Discounts
  • Drugs used to treat anorexia, weight loss, or weight gain. ...
  • Fertility drugs.
  • Drugs used for cosmetic purposes or hair growth. ...
  • Drugs that are only for the relief of cold or cough symptoms.
  • Drugs used to treat erectile dysfunction.
  • Prescription vitamins and minerals (except prenatal vitamins and fluoride preparations)

How much is Medicare Part D 2023?

The estimated average monthly premium for Medicare Part D stand-alone drug plans is projected to be $43 in 2023, based on current enrollment, a 10% increase from $39 in 2022 – a rate of increase that outpaces both the current annual inflation rate and the Social Security cost-of-living adjustment for 2023.

Why get Part D Medicare?

Medicare Part D, the prescription drug benefit, is the part of Medicare that covers most outpatient prescription drugs. 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 your Medicare Advantage Plan.

Is Medicare Part D expensive?

The chart below provides general Medicare drug costs for 2023. Varies by plan. Average national premium is $32.74. People with high incomes have a higher Part D premium.

What drugs are included in Medicare Part B?

A List of the Types of Drugs Covered by Medicare Part B
  • Certain Vaccines. ...
  • Drugs That Are Used With Durable Medical Equipment. ...
  • Certain Antigens. ...
  • Injectable Osteoporosis Drugs. ...
  • Erythropoiesis-Stimulating Agents. ...
  • Oral Drugs for ESRD. ...
  • Blood Clotting Factors. ...
  • Immunosuppressive Drugs.

How do you qualify to get $144 back from Medicare?

To qualify for the giveback, you must:
  1. Be enrolled in Medicare Parts A and B.
  2. Pay your own premiums (if a state or local program is covering your premiums, you're not eligible).
  3. Live in a service area of a plan that offers a Part B giveback.

Can you drop Medicare Part B anytime?

You can voluntarily terminate your Medicare Part B (Medical Insurance). However, you may need to have a personal interview with Social Security to review the risks of dropping coverage and to assist you with your request.

Can you change Medicare Part D every year?

Your Medicare Annual Enrollment Period (AEP) , sometimes called the Fall Open Enrollment Period, runs from Oct. 15 to Dec. 7 each year. During this time, you may make changes to your Part D plan or switch to a new one.

How do I add Part D to an existing Medicare plan?

Part D enrollment

To enroll in a Part D plan, you can do any of the following: Call 1-800-MEDICARE. Counselors are available to guide you through your options and enroll you in a plan. It is a good idea to enroll through 1-800-MEDICARE to avoid administrative errors.

What is the Part D coverage gap in 2023?

Once you and your plan have spent $4,660 on covered drugs in 2023, you're in the coverage gap. This amount may change each year. Also, people with Medicare who get Extra Help paying Part D costs won't enter the coverage gap.

How much is Medicare Part B?

Most people pay the standard Part B monthly premium amount ($164.90 in 2023). Social Security will tell you the exact amount you'll pay for Part B in 2023. You pay the standard premium amount if you: Enroll in Part B for the first time in 2023.

Is Part D deducted from Social Security?

If you are getting Medicare Part C (additional health coverage through a private insurer) or Part D (prescriptions), you have the option to have the premium deducted from your Social Security benefit or to pay the plan provider directly.

Is Medicare going up in 2023?

For 2023, the Part A deductible will be $1,600 per stay, an increase of $44 from 2022. For those people who have not worked long enough to qualify for premium-free Part A, the monthly premium will also rise. The full Part A premium will be $506 a month in 2023, a $7 increase.

What percentage does Medicare Part D pay for prescriptions?

In 2023, once you incur $4,660 in drug costs, you'll pay 25 percent of your brand-name and generic prescription drug costs. Once your out-of-pocket costs reach $7,400, Part D's catastrophic coverage kicks in and for the rest of the year you'll pay no more than 5 percent of your drug costs.