{"id":6461,"date":"2024-12-10T10:11:35","date_gmt":"2024-12-10T10:11:35","guid":{"rendered":"https:\/\/healthmedicinet.com\/review\/hmn-does-medicare-part-b-cover-prescriptions-in-2025\/"},"modified":"2024-12-20T09:33:55","modified_gmt":"2024-12-20T09:33:55","slug":"hmn-does-medicare-part-b-cover-prescriptions-in-2025","status":"publish","type":"post","link":"https:\/\/healthmedicinet.com\/review\/hmn-does-medicare-part-b-cover-prescriptions-in-2025\/","title":{"rendered":"HMN: Does Medicare Part B cover prescriptions? in 2025"},"content":{"rendered":"<p>\n<br \/>Do you know:  Does Medicare Part B cover prescriptions? in 2025<\/p>\n<div id=\"main-content\">\n<div id=\"post-intro\">\n<div id=\"takeaways\">\n<h2>Key takeaways<\/h2>\n<ul>\n<li>\n<p>Medicare Part B covers outpatient medical services, some outpatient prescription drugs, and medications like some chemotherapy drugs, vaccines, and insulin for pumps, typically administered in a doctor\u2019s office or hospital setting.<\/p>\n<\/li>\n<li>\n<p>The standard Medicare Part B premium for 2025 is $185, which may increase based on income, with a deductible of $257 and typically 20% coinsurance after the deductible is met.<\/p>\n<\/li>\n<li>\n<p>Medicare Part D is designed to cover FDA-approved prescription drugs that are regularly taken at home, with a monthly premium averaging $36.78, and it does not cover drugs that are covered under Medicare Part A or B.<\/p>\n<\/li>\n<li>\n<p>Enrolling in both Medicare Part B and Part D can provide comprehensive coverage for both outpatient medical services and regular prescription medications, with Medicare Advantage plans (Part C) offering an alternative that includes Parts A, B, and usually D coverage.<\/p>\n<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<p><span style=\"font-weight: 400;\">Most people who are familiar with Medicare think of<\/span> <span style=\"font-weight: 400;\">Part D<\/span><span style=\"font-weight: 400;\"> when asked about prescription drug coverage. But did you know that <\/span><span style=\"font-weight: 400;\">Medicare Part B<\/span><span style=\"font-weight: 400;\"> covers some medications, too? If you\u2019ve recently been diagnosed with a health condition, you may be wondering which part of Medicare will help you get the most affordable treatment.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">What is Medicare Part B?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">This part of Medicare covers outpatient medical services, durable medical equipment, such as<\/span> <span style=\"font-weight: 400;\">insulin pumps<\/span><span style=\"font-weight: 400;\">, and preventive healthcare services.<\/span><\/p>\n<p><a href=\"https:\/\/www.medicare.gov\/coverage\/prescription-drugs-outpatient\" target=\"_blank\" rel=\"noopener\"><b>Medicare Part B covers<\/b><\/a><b>:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Doctor\u2019s visits, including preventive services and annual physical exams<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Clinical research trials<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ambulance services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Durable medical equipment<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Outpatient mental health services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Some (but not most) outpatient prescription drugs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Some vaccinations<\/span><\/li>\n<\/ul>\n<p><b><\/b> <b>Does Medicare cover flu shots?<\/b><\/p>\n<h2><span style=\"font-weight: 400;\">Does Medicare Part B cover prescriptions?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Medicare Part B does cover <\/span><i><span style=\"font-weight: 400;\">some<\/span><\/i><span style=\"font-weight: 400;\"> prescriptions.<\/span> <span style=\"font-weight: 400;\">Insulin<\/span><span style=\"font-weight: 400;\"> used in external insulin pumps (if medically necessary), some drugs prescribed during dialysis are covered, and some chemotherapy drugs and outpatient oral cancer drugs.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Other drugs covered by Part B include those administered by a healthcare professional in a doctor\u2019s office or another medical facility. These include vaccines and other injectable drugs and drugs that are administered through a feeding tube.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">List of drugs covered by Medicare Part B<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Certain drugs are covered by Medicare Part B under limited conditions, usually in a doctor\u2019s office or hospital setting. Medicare Part B drugs include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Drugs used in conjunction with durable medical equipment such as infusion pumps or nebulizers<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Antigens that are prepared by your doctor<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Injectable osteoporosis drugs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Erythropoiesis-stimulating agents for those with end-stage renal disease<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Blood clotting factors<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Injectable and infused drugs\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Oral end-stage renal disease (ESRD) drugs including Parsabiv and Sensipar<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Parenteral (intravenous)\u00a0 and enteral (tube) nutrients<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Intravenous immune globulin (IVIG)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Vaccinations (flu, pneumococcal, Hepatitis B, and others)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Immunosuppressant drugs related to organ transplant<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Oral cancer drugs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Oral anti-nausea drugs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Self-administered drugs in a hospital setting<\/span><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">How much does Medicare Part B cost?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The standard<\/span> <span style=\"font-weight: 400;\">Medicare Part B premium for<\/span><span style=\"font-weight: 400;\"> 2025 is $185, but this premium may increase if your income falls above a certain level. The Social Security Administration uses the income reported on your most recent federal tax return to determine whether you will be responsible for paying any additional premium during your enrollment. Premiums may increase depending on income, however, there are no income limits to being able to receive Medicare benefits.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">What is the difference between Part B and Part D?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Although both cover medications, there are a few key differences between drug coverage under Medicare Part B and Medicare Part D drug coverage. The medications covered under Medicare Part B are drugs that would typically be administered by a healthcare provider at a hospital or doctor\u2019s office. Medicare Part D coverage provides additional drug coverage to lower out-of-pocket costs on prescription medications you take regularly at home.<\/span><\/p>\n<table class=\" singlecare-table\">\n<thead>\n<tr>\n<th>\n<h2><span class=\"title\">Medicare prescription drug coverage: Part B vs. Part D<\/span><\/h2>\n<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td><b>Eligibility<\/b><\/td>\n<td><span style=\"font-weight: 400;\">If you are eligible to enroll in Medicare Part A (65+ years old, on social security disability for 2 years, end-stage renal disease, or ALS), you are eligible to enroll in Part B.<\/span><\/td>\n<td><span style=\"font-weight: 400;\">You must be enrolled in Medicare Part A and\/or Part B to enroll in Medicare Part D.<\/span><\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\"><b>Enrollment<\/b><\/td>\n<td><span style=\"font-weight: 400;\">Initial enrollment period begins 3 months before your 65th birthday and ends 3 months after the month of your birthday (for a total period of 7 months).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If you miss the initial enrollment period, you may have to pay a monthly late enrollment penalty for the entire duration of time that you are enrolled in Part B, unless you have low income or creditable coverage.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Thereafter, the open enrollment period is between Jan. 1-March 31 annually.<\/span><\/p>\n<\/td>\n<td><span style=\"font-weight: 400;\">Initial enrollment period begins 3 months before your 65th birthday and ends 3 months after the month of your birthday (for a total period of 7 months).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If you miss the initial enrollment period, you may have to pay a monthly late enrollment penalty for the entire duration of time that you are enrolled in Part D, unless you have low income or creditable coverage.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Thereafter, the open enrollment period is between Oct. 15-Dec. 7 annually.\u00a0<\/span><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\"><a href=\"https:\/\/www.medicare.gov\/basics\/get-started-with-medicare\/get-more-coverage\/joining-a-plan\/special-enrollment-periods\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Special Enrollment Periods also apply<\/span><\/a><\/td>\n<\/tr>\n<tr>\n<td><b>Costs*<\/b><\/td>\n<td>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Monthly premium: $185 in 2025, which may increase based on income<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Deductible: $257 in 2025<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Coinsurance: After the deductible is met, you will typically pay 20% of Medicare-approved medical costs<\/span><\/li>\n<\/ul>\n<\/td>\n<td>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The national base premium is $36.78 in 2025, but this varies by plan<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Deductible: $0-$590 in 2025<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Copays\/coinsurance: Varies based on your specific plan<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td><b>Covered drugs<\/b><\/td>\n<td>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Drugs that are given in a doctor\u2019s office or hospital and that typically cannot be self-administered (usually via infusion or injection)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Vaccinations, including the flu shot, COVID-19 vaccine, hepatitis B shots, and pneumococcal shots\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Some antigens, erythropoietin by injection, blood clotting factors, immunosuppressive drugs, oral cancer drugs, oral anti-nausea drugs, parenteral and enteral nutrition, intravenous immune globulin, and insulin used with insulin pumps<\/span><\/li>\n<\/ul>\n<\/td>\n<td><span style=\"font-weight: 400;\">Medicare Part D covers FDA-approved prescription drugs that are regularly taken at home. See your plan\u2019s formulary to find out which drugs are covered.<\/span><\/td>\n<\/tr>\n<tr>\n<td><b>Other considerations<\/b><\/td>\n<td><span style=\"font-weight: 400;\">Medicare Part B generally does not cover drugs that are administered in a hospital emergency department or hospital inpatient unit.<\/span><\/td>\n<td><span style=\"font-weight: 400;\">By law, Medicare Part D cannot pay for any medications that Part A or Part B covers. The following drugs also aren\u2019t covered by Part D:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Weight-loss drugs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Sexual or erectile dysfunction drugs, unless used off-label for an FDA-approved reason<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Cough and cold medication<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Non-prescription drugs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Fertility drugs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hair growth drugs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Drugs taken for cosmetic reasons<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prescription vitamins and minerals, with the exceptions of prenatal vitamins and fluoride<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><i><span style=\"font-weight: 400;\">*These costs are reduced or eliminated if a person is low-income and enrolls in a Medicare Savings Program, or MSP (for Part B) or Extra Help (for Part D).<\/span><\/i><\/p>\n<h2><span style=\"font-weight: 400;\">Bottom line: You may need Medicare Part B <\/span><i><span style=\"font-weight: 400;\">and<\/span><\/i><span style=\"font-weight: 400;\"> Part D<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">You may not foresee needing the type of drugs that Medicare Part B covers; however, if you don\u2019t enroll in Part B, you\u2019ll also be missing out on coverage for doctor\u2019s visits, ambulance services, and durable medical equipment.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If you think you need Medicare Part B and Part D coverage, you can consider a Medicare Advantage plan (also known as Part C) instead of Original Medicare (Part A and B). <\/span><span style=\"font-weight: 400;\">Medicare Advantage<\/span><span style=\"font-weight: 400;\"> includes Part A (inpatient hospital insurance), Part B (outpatient medical insurance), and usually Part D (drug coverage). However, Medicare Advantage will change the way your Medicare is administered including networks, prior approval, and other implications.\u00a0<\/span><\/p>\n<p><b> <\/b><b>Original Medicare vs. Medicare Advantage<\/b><\/p>\n<p><span style=\"font-weight: 400;\">For even more coverage with Original Medicare, consider a Medicare supplement plan like <\/span><span style=\"font-weight: 400;\">Medigap<\/span><span style=\"font-weight: 400;\">. Eligible Medicare beneficiaries can also apply for low-income subsidies like <\/span><span style=\"font-weight: 400;\">Medicare Savings Programs<\/span><span style=\"font-weight: 400;\"> or <\/span><span style=\"font-weight: 400;\">Medicare Extra Help<\/span><span style=\"font-weight: 400;\"> to lower prescription drug costs and other Medicare-related expenses.<\/span><\/p>\n<p><svg style=\"display:none\">\n  <g id=\"facebook\">\n    <rect width=\"32\" height=\"32\" rx=\"4\" fill=\"var(--social-bg)\"\/>\n    <path fill=\"var(--social-ico)\" d=\"M19.51 9.32003H21.39V6.14003C20.4798 6.04538 19.5652 5.99865 18.65 6.00003C15.93 6.00003 14.07 7.66003 14.07 10.7V13.32H11V16.88H14.07V26H17.75V16.88H20.81L21.27 13.32H17.75V11.05C17.75 10 18.03 9.32003 19.51 9.32003Z\"\/>\n  <\/g>\n  <g id=\"twitter\">\n    <rect width=\"32\" height=\"32\" rx=\"4\" fill=\"var(--social-bg)\"\/>\n    <path fill=\"var(--social-ico)\" d=\"M26 9.9506C25.2483 10.2767 24.4534 10.4923 23.64 10.5906C24.4982 10.0779 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