Medicare Part B vs. Part D
Learn the basics of Medicare Part B and Part D, how they differ and when to use either coverage for certain prescription drugs.
What is Medicare Part B?
Confused about the different parts of Medicare and what each part covers? HealthSpring can help.
Let’s first discuss Original Medicare. Original Medicare is made up of two main parts. They are Part A and Part B. In general, Part A is your hospital insurance. And Part B is your medical insurance.
Part B covers many of your medically necessary services not covered by Part A, including:
Certain medications you take that are prescribed by your doctor or at a hospital (often called Part B drugs)
Durable medical equipment (DME), like diabetic test strips, nebulizers and wheelchairs
Routine preventive services, like your initial “Welcome to Medicare” and annual wellness visits
Home health care
You are eligible for Part B if you are 65 or older, disabled, in end-stage renal disease or diagnosed with ALS (amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease).
You can get Part B medical coverage through your former employer, a standalone plan or directly from Medicare.
Part B is optional because you have to pay a monthly premium, which is based on your income. And, you have to meet the deductible before Medicare will pay benefits.
With Original Medicare Part B, you get coverage for:
Annual preventive doctor visits Outpatient care Medical supplies Some preventive services
Items that are often covered by Medicare Part B:
Certain medications (commonly referred to as Part B drugs) Durable medical equipment (wheelchairs, diabetic test strips, nebulizers, etc.) Specialty pharmacy drugs Mail-order pharmacy drugs
What is Medicare Part D?
Medicare Part D is your prescription drug coverage. Part D pays for medications you take regularly to manage chronic conditions, like heart disease, high cholesterol or asthma. It also pays for any drugs you take for a short period of time, such as antibiotics.
Part D works with Original Medicare (Part A and Part B). Or Part D may be included in a Medicare Advantage plan (Part C).
If you are entitled to Original Medicare Part A and/or enrolled in Medicare Part B, there are 2 ways you can get Part D Prescription Drug coverage:
Enroll in a separate, or standalone, Medicare Part D Prescription Drug plan (when you turn 65 or during Open Enrollment)
Enroll in a Medicare Advantage plan (Part C) that includes drug coverage (not all Medicare Advantage plans include drug coverage)
You pay a Part D premium every month. This is a flat fee you have to pay for your plan for providing you with coverage. You must continue to pay your Part B premium.
Let’s learn more about Medicare Part D Prescription Drug Plans
What’s the difference between Medicare Part B and Part D?
You now know that Medicare Part B covers medical care. And Medicare Part D covers most prescription drugs.
But there are times when you will need to use your Part B medical coverage for certain types of prescription drugs. For example, the medications you get at your doctor’s office. Or those prescribed to you in a hospital outpatient setting. These medical prescriptions are often called Part B drugs.
And not all items that you buy at a pharmacy are covered by your Part D prescription drug plan. Certain health supplies and other pharmacy-related items are covered by your Medicare Part B plan.
Many retail pharmacies, such as a pharmacy in Walgreens, CVS or other retail store, cannot bill a medical plan for Medicare medical prescriptions (Part B drugs) or medical equipment.
If you need Part B drugs or medical equipment, ask your pharmacist if they can bill your medical plan directly. Or you may consider using one of these types of specialty service providers:
Medical equipment
Home infusion
Home health care
Specialty pharmacy
Medical specialty service
Mail-order pharmacy
Which prescription drugs are covered by Medicare Part B?
While Part D offers a wider range of prescription coverage, Medicare Part B only covers certain medications for some health conditions.
Part B drugs are often administered by a health care provider. Examples of these include vaccines, injections, infusions and nebulizers. Or the prescription drugs may be given to you through medical equipment in your home.
With a Medicare Part B plan, your drug coverage includes:
Injections for osteoporosis
Some transplant medications
Immunosuppressants
End-stage renal disease (ESRD) medications
Flu, pneumonia and Hepatitis B shots
Medicare Part D may cover medications that aren’t covered under Part B and vice versa. When you are choosing a Medicare plan, it is important to make sure the plan will cover your current medication needs.