Does Medicare cover prescription drugs in 2025?

Medicare does cover prescription drugs, and Medicare Part D is the primary coverage for prescriptions.

Medicare may also cover drugs with Parts A, B, and C in certain instances, but for complete prescription drug coverage, customers must enroll in Medicare Part D or a Medicare Advantage Prescription Drug (MAPD) Plan. A MAPD plan is Medicare Advantage (Part A and B) plus a prescription drug plan (Part D).

Read on to learn more about Medicare prescription plans. To speak with a licensed insurance agent about your Medicare Part D needs, call (855) 634-0435 today. You may also enter your ZIP in our free tool for free quotes.

Medicare Prescription Drug Coverage by Part

What do drug plans cover? Prescription drug coverage under Parts A, B, C, and D is different, depending on what parts you have on your policy and how the prescription is administered.

You will need to have Part D on your Medicare plan for prescription drugs to be covered in all situations, but you may have some limited drug coverage with Parts A and B.

Prescription drug coverage under Medicare parts also depends on whether drugs are inpatient, doctor-administered, or outpatient prescriptions.

For example, Part A only covers inpatient drugs during hospital stays, so any drugs patients need once discharged won’t be covered.

As for Medicare Part B, the list of medications covered by Medicare Part B includes only medical drugs.

These drugs are often doctor-administered in a medical office, such as vaccines. Some common drugs covered under Medicare Part B, in addition to vaccines, include:

• Antigens
• Blood-clotting drugs
• Dialysis drugs
• Durable Medical Equipment (DME) drugs
• Injectable/infused drugs

Medicare Part C will cover prescription drugs if you have Part D as part of your bundle under an advantage. If you don’t have Part D on your Part C plan, then you won’t have outpatient drug coverage.

If you have Part D, whether separately or under a Medicare Advantage Prescription Drug (MAPD) Plan, your outpatient prescription drugs will be covered.

Medicare Prescription Drug Coverage Overview

While there is some drug coverage on all Medicare Parts, one coverage that does not cover prescription drugs is Medicare supplemental insurance (Medigap) coverage.

Medigap insurance helps cover the out-of-pocket costs of Medicare Part A and B, but it does not help cover any prescription drug charges.

Medicare Costs by Plan Type

The cost of each Medicare part will also play a role in what prescription drug coverage customers choose. Medicare Part D costs an average of $34 per month to add to a Medicare plan, with an out-of-pocket maximum of $2,000

The cost of Medicare Part C can range from $0 to $200 a month and has an out-of-pocket maximum of $8,850 (Read More: Medicare Advantage Maximum Out-of-Pocket).

Medicare Part D Coverage

Medicare Part D has the most complete prescription drug coverage out of Medicare Parts A, B, C, & D. Part D will help cover drugs that are excluded by other parts. For example, some common medications covered by Medicare Part D include antibiotics, antidepressants, and diabetes medications.

Drugs that aren’t prescription are excluded under Part D, as well as under other Medicare Parts. Some examples of excluded medications include:

• Over-the-counter drugs
• Weight loss/gain drugs
• Fertility drugs
• Cosmetic/hair growth drugs

Additionally, any drugs covered under Part A or Part B will not be covered under Part D, as Part A or B will be charged the drug cost.

Medicare Part D can be added to your plan as long as you have Medicare Part A or Part B. If you are buying a Medicare Advantage Plan, you will need to have Part A and Part B to add on Part D.

Comparing Medicare Part D vs. MAPD Plans

There are key differences between Medicare Part D prescription drug plans and Medicare Advantage Prescription Drug (MAPD) plans.

Medicare Part D is a standalone plan that provides prescription drug coverage, which can be added to Original Medicare. It does not include medical or hospital benefits.

Part D vs. Medicare Advantage Prescription Drug (MAPD) Plan

MAPD plans differ from standalone Part D coverage because they combine multiple types of Medicare benefits. An MAPD plan includes Medicare Part A for hospital coverage, Part B for medical coverage, and Part D for prescription drugs.

Although MAPD plans often have higher premiums than standalone Part D plans, they provide more comprehensive coverage. These bundled plans include both medical and prescription benefits and come with an annual out-of-pocket maximum.

How Medicare Defines Prescription Drugs

So what is a prescription drug? Prescription drugs are medicines that need a doctor’s authorization, compared to over-the-counter drugs that you can purchase without a doctor’s prescription.

Medicare has several tiers that define what prescription drugs are covered under Medicare plans. You can find a list of these tiers on your plan when you sign up for Medicare.

Generic drugs are tier one and will be the lower-cost medications that have cheaper copays. Tier two drugs are more common brand-name medications that are preferred by Medicare plans and will likely cost slightly more than tier one drugs.

Tier three drugs are still brand-name drugs, but they are less commonly used and therefore cost more. You will get a more specific list of prescription drugs covered by Medicare when you sign up for a plan.

Medicare Prescription Drug Formulary Levels

Specialty drugs fall under tier four because they are high-cost or specialty meds, such as those used to treat cancer and other serious health conditions.

The last tier, tier five, is non-formulary drugs. These are expensive medications used to treat rare conditions, and are typically not on the list of drugs covered by Medicare unless approved on the plan.

Most Common Health Issues Covered by Medicare Prescription Plans

When we break down prescription drug spending under Medicare, Part D drug coverage spends the most on diabetes medications at 30%, with cancer medications coming in a close second at 25%.

If your enrollment period is coming up and you aren’t sure if you want to add prescription drug coverage to your Medicare plan because of the extra Medicare costs, it can be helpful to know what types of drugs Medicare spends the most on.

If you have any of these conditions or are at risk for any of these conditions, then it is likely in your best interest to invest in Medicare prescription drug coverage.

Without it, you will be stuck paying for your medications with little to no assistance from your Medicare insurance.

Eligibility for Medicare Prescriptions

There are a few requirements you must meet to qualify for prescription drug coverage under Medicare, including having a U.S. address.

First, you must qualify for Medicare coverage, Part A or B, to be able to add prescription drug coverage to your plan (Learn More: Who is eligible for Medicare?).

If you are enrolled in Medicare Part A or B, you can add prescription drug coverage by adding Part D to your plan.

You may also opt to purchase a Medicare Advantage plan that includes Part D, or purchase a MAPD plan.

Medicare Prescription Drug Requirements

You can enroll in a Medicare prescription drug plan during the initial or special enrollment periods.

Initial enrollment is three months before or after a customer turns 65. Special enrollment periods vary, based on the qualifying event.

Medicare Enrollment Periods: Key Details

If you enroll in a prescription drug plan after the designated enrollment period, you may be charged a late enrollment penalty.

Because of this, it is best to decide if you want to add prescription drug coverage to your Medicare plan before your enrollment period to avoid late fees.

Get Help Covering Prescription Drug Costs

If you are having trouble affording your prescription drugs or paying for Medicare prescription drug coverage, there are a few things you can do to get assistance with costs.

For example, you may be able to get help from State Pharmaceutical Assistance Programs (SPAPs) for Rx drugs. You can also look for pharmacy discount cards to find the best cost for your medication.

Medicare Prescription Drug Assistance Programs

You may also qualify for some Medicare assistance programs, like the Medicare Savings Programs, that can help reduce your costs.

Medicare Savings Programs will not be available to higher-income customers, so you must have a lower income threshold to qualify.

While Medicare does cover prescription drugs, the drugs covered by Medicare depend on your plan and prescription needs, as well as what you can afford to purchase. Part D or MAPD plans are the best way to get outpatient drug coverage.

Interested in learning more about Part D enrollment and costs? Speak with a licensed insurance agent today about your Medicare Part D needs by calling (855) 634-0435. Or enter your ZIP code in our free quote tool.