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Veterans Benefits And Medicare Coverage

Many veterans assume their health coverage through the U.S. Department of Veterans Affairs automatically replaces Medicare. In reality, veterans benefits and Medicare coverage serve different roles and understanding how they coordinate can help avoid costly coverage gaps.

VA Benefits and Medicare Are Separate Systems

Healthcare through the U.S. Department of Veterans Affairs (VA) provides coverage for care received at VA hospitals and clinics. However, VA benefits generally do not pay for services received outside of the VA system unless preauthorized.

Medicare, on the other hand, provides coverage nationwide through private providers who accept Medicare. Because these systems do not automatically coordinate payments, having one does not replace the need for the other.

Why Many Veterans Enroll in Medicare

Even if a veteran primarily uses VA facilities, enrolling in Medicare at age 65 is a good idea. Here’s why:

• Access to Non-VA Providers: If a veteran wants care outside the VA system, Medicare helps cover those services.
• Emergency Flexibility: Emergency situations may arise far from a VA facility.
• Avoiding Late Enrollment Penalties: Delaying Medicare Part B without other qualifying coverage can lead to lifelong penalties.

VA drug coverage is considered creditable, so some veterans delay Medicare Part D without penalty. However, each situation should be reviewed carefully.

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How Medicare Advantage Fits In

Some veterans choose a Medicare Advantage (Part C) plan. These plans combine hospital, medical, and often prescription coverage into one plan administered by private insurance companies approved by Medicare.

For veterans, a Medicare Advantage plan can:

• Expand access to local doctors and hospitals
• Provide additional benefits like dental, vision, hearing, and fitness programs
• Offer prescription coverage for medications filled outside VA pharmacies

Importantly, veterans can still use VA facilities while enrolled in a Medicare Advantage plan. The two do not cancel each other out; they simply cover services in different settings.

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TRICARE and Medicare

For military retirees and certain dependents enrolled in TRICARE for Life, Medicare enrollment is required at age 65. Medicare becomes primary coverage, and TRICARE for Life acts as secondary coverage, often reducing out-of-pocket costs significantly.

VA benefits, Medicare, and TRICARE each play distinct roles. For many veterans, having both VA coverage and Medicare provides broader access, greater flexibility, and stronger financial protection. Reviewing options before turning 65 ensures veterans maximize the benefits they’ve earned through their service.

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Healthfirst Medicare Advantage & Long-Term Care Plans in 2026

As you help clients navigate Medicare options, it’s important understand Healthfirst Plan Benefits 2026. The plan lineup serves diverse needs; from dual-eligible beneficiaries to those seeking broader provider choice or long-term care coordination. Healthfirst offers a range of Medicare Advantage (MA) and Special Needs Plans (SNPs), as well as long-term services supports (MLTC). Each plan is designed to provide more than Original Medicare alone.

Medicare Advantage Plans

Healthfirst Life Improvement Plan (HMO D-SNP)

Is a Dual-Eligible Special Needs Plan for members with both Medicare and Medicaid coverage. This HMO D-SNP combines hospital, medical and Part D drug coverage as well as extras like an OTC Plus card, dental, vision, hearing, and fitness benefits. Most plans offer a $0 monthly premium and low or no copays for most services

Healthfirst Connection Plan (HMO D-SNP)

This plan is another D-SNP option for dual-eligible members. It focuses on helping those with both Medicare and Medicaid cost-sharing assistance. It offers enrollees a $0 monthly premium, prescription drug coverage, an OTC Plus card as well as low or no copays for covered services.

Healthfirst CompleteCare Plan (HMO D-SNP)

Designed for dual-eligible members who need nursing home level of care or community-based long-term services, CompleteCare integrates Medicare and Medicaid benefits with extra support, including home care, adult day healthcare, a Care Team, and a robust OTC Plus card. Premiums and most copays are $0, and the plan includes dental, vision, and hearing benefits.

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Healthfirst Increased Benefits Plan (HMO)

This HMO is ideal for members who qualify for Extra Help (LIS). It offers $0 premium for those with LIS, Part D coverage, an OTC Plus card, and low or no copays all bundled with hospital and medical coverage. Premiums may vary if LIS status changes.

Healthfirst 65 Plus Plan (HMO)

A core HMO plan for those seeking comprehensive Medicare Advantage coverage, this $0 premium MAPD includes hospital, medical, and prescription drug coverage, an OTC Plus card, and enhanced benefits beyond Original Medicare.

Healthfirst Signature (HMO)

A popular HMO MAPD that includes hospital, medical, and Part D benefits with a $0 monthly premium and a Flex card to help cover dental, vision, hearing, fitness, and other out-of-pocket costs. No referrals are needed for in-network specialists.

Healthfirst Signature (PPO)

For clients who value provider flexibility, this PPO allows visits to in-network and out-of-network providers that accept Medicare. It typically carries a low monthly premium, includes Part D prescription coverage and core MAPD benefits like dental, vision, and hearing.

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Long-Term Care & Managed Care

Healthfirst CompleteCare HMO D-SNP

In addition to regular Medicare Advantage SNP benefits, this plan includes Long-Term Services and Supports (LTSS), caregiver support, and coordinated care for members needing ongoing assistance to remain independent at home.

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Senior Health Partners Managed Long‑Term Care Medicare Plan

This MLTC Medicaid Plan focuses on coordinating long-term care services like home care and adult day care. It’s tailored for those Medicaid-eligible members who require extended support beyond typical Medicare benefits.

As you can see, Healthfirst’s 2026 portfolio provides options for a range of member needs; from basic MAPD coverage to dual-eligible benefits and long-term care support. This makes it easy to match clients to plans that fit their clinical and financial profiles.

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What Medicare Part D Covers: A Clear Guide for Medicare Beneficiaries

Medicare Part D is essential for millions of beneficiaries who rely on prescription medications to manage chronic conditions and maintain their health. Understanding what Medicare Part D covers can help you choose the right plan, avoid unexpected costs, and make the most of your Medicare benefits. This guide breaks down the key features of Part D coverage so you know exactly what to expect.

What Is Medicare Part D

Medicare Part D is prescription drug coverage offered by private insurance companies approved by Medicare. Beneficiaries can enroll in a stand-alone Prescription Drug Plan (PDP) with Original Medicare or choose a Medicare Advantage plan (MA-PD) that includes drug benefits. Every plan must follow Medicare’s minimum coverage rules, but formularies and pricing vary.

What Medicare Part D Covers

Prescription Drugs in Essential Categories

All Medicare Part D plans must cover drugs across major therapeutic classes, including medications for:

• Diabetes
• High blood pressure
• High cholesterol
• COPD and asthma
• Depression and anxiety
• Osteoporosis

This ensures beneficiaries have access to commonly used medications for chronic conditions.

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Protected Class Medications

Medicare Part D also requires plans to cover “protected class” drugs, which include:

• Antidepressants
• Antipsychotics
• Anticonvulsants
• Antiretrovirals
• Immunosuppressants
• Certain cancer medications

These protections ensure that people with serious or complex health needs can access the full range of necessary treatments.

Vaccines Not Covered by Part B

Part D covers many important vaccines, including the shingles (Shingrix) vaccine, RSV vaccines, and most travel immunizations. Under current Medicare rules, beneficiaries typically pay $0 out of pocket for recommended vaccines.

Insulin and Diabetic Supplies

Thanks to recent updates, Medicare Part D limits monthly insulin costs to $35 for covered insulin products. Many plans also cover diabetic supplies such as test strips, lancets, and pen needles.

Specialty and High-Cost Medications

Part D covers a wide range of specialty drugs used for conditions like multiple sclerosis, rheumatoid arthritis, and autoimmune disorders. These medications may fall into higher cost tiers but are included in most formularies.

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What Medicare Part D Does Not Cover

Medicare Part D does not cover over-the-counter drugs, vitamins and supplements, cosmetic medications, fertility treatments, or drugs for weight loss.

Medicare Part D provides comprehensive, affordable access to prescription medications. By reviewing your plan’s formulary, comparing costs, and choosing a plan that matches your medication needs, you can maximize your coverage and save money throughout the year.

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Medicare Part B in 2026: What to Expect

Medicare beneficiaries will see several important changes to Medicare Part B 2026. Costs are rising again, and many retirees will feel the impact. Here is a simple breakdown of what’s changing and why it matters.

Key Cost Changes for 2026

The standard monthly Part B premium increases to $202.90 in 2026. This is a noticeable jump from the 2025 premium of $185.00. The annual deductible also rises. It increases to $283, up from $257 in 2025.

After you meet the deductible, you still pay 20% coinsurance for most Part B services. This includes doctor visits, outpatient care, therapy, lab work, and durable medical equipment. These basic cost-sharing rules do not change.

Why These Costs Are Going Up

Medicare adjusts Part B premiums each year. These changes reflect the rising cost of healthcare. More people are using outpatient services. Physician-administered drugs also continue to drive spending.

CMS noted that the increase could have been even higher. Cost-saving steps helped reduce the size of the jump. One example is new rules designed to slow spending on certain high-priced items, such as skin substitutes. Still, higher medical costs overall mean higher premiums for beneficiaries.

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What This Means for You

Higher premiums and a higher deductible mean higher yearly expenses. The extra $18 per month adds up. Over the course of a year, it is more than $200. This does not include the out-of-pocket costs you may pay when you receive care.

Budgeting becomes even more important in 2026. If you expect frequent doctor visits or outpatient treatments, you may face additional costs throughout the year.

For many people, supplemental coverage can help. Medigap plans can reduce out-of-pocket expenses. Medicare Advantage may also offer lower upfront costs. However, each option has different benefits and limits. It is important to compare them carefully.

Check Your Income Level

Some people will pay more than the standard premium. If your income is above certain thresholds, you may owe an Income-Related Monthly Adjustment Amount (IRMAA). This surcharge increases your monthly cost. It is based on your tax return from two years prior.

Medicare Part B costs will increase again in 2026. These changes affect almost every beneficiary. Reviewing your coverage now can help you avoid surprises later. Look at your budget, your health needs, and your income level. Then decide whether Original Medicare alone is enough or if a supplemental option makes sense for you.

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Medicare Supplement Plan Sales Growth

As Medicare Advantage plans undergo major changes for 2026, more seniors are taking a closer look at Medicare Supplement (Medigap) coverage. With tighter MA budgets, reduced benefits, and growing network concerns, Medigap is becoming the go-to choice for beneficiaries who want simplicity, stability, and predictable healthcare costs. This has helped with Medicare Supplement plan sales growth.

Why Medicare Advantage Changes Are Driving the Shift

For 2026, many Medicare Advantage carriers are reducing cost-sharing perks, scaling back extras, and becoming more selective with enrollment growth. Factor in increased marketing scrutiny and commission pressure, and the MA landscape feels less predictable than it has in years.

Seniors are noticing; many are now reevaluating whether MA plans still fit their needs.

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Why Medicare Supplement Plans Stand Out in 2026

1. Predictable Costs and Simple Coverage

Medigap helps shield members from unexpected bills by covering the gaps in Original Medicare. Plan G and other popular options remain consistent year after year.

2. Freedom From Networks

Members can see any doctor or hospital nationwide that accepts Medicare; no referrals, no authorizations, and no surprises.

3. Long-Term Stability

While MA benefits change annually, Medigap benefits do not. This makes Medigap especially appealing amid shifting MA offerings.

How to Position Medigap in Your Sales Strategy

• Lead with predictability: Emphasize long-term cost stability compared to fluctuating MA benefits.
• Highlight provider freedom: Seniors frustrated with shrinking MA networks respond well to Medigap’s nationwide access.
• Target MA switchers: Many beneficiaries use the Medicare Advantage Open Enrollment Period to move into more stable coverage.
• Educate early: Start conversations before annual plan changes create confusion or frustration.

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Key Takeaways

• Medicare Advantage plans are cutting back on supplemental benefits and tightening networks for 2026.
• Medicare Supplement plans offer predictability, nationwide access, and long-term stability.
• Demand is increasing as seniors seek more control and fewer surprises.
• Agents can leverage this shift to build trust, long-term relationships, and stronger retention.

As Medicare Advantage plans tighten benefits in 2026, Medicare Supplement insurance stands out as a stable, reliable alternative. For agents, this shift presents a strong opportunity to guide clients toward coverage that offers flexibility, control, and predictable healthcare spending.

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Medicare Part B Enrollment Periods

Medicare Part B is a vital part of your healthcare coverage, helping to pay for doctor visits, outpatient care, preventive services, and medical supplies. However, knowing when to sign up is just as important as understanding what Part B covers. Enrolling at the right time ensures you avoid costly late penalties and gaps in coverage. Here’s a breakdown of the key Medicare Part B enrollment periods and what each means for you.

Initial Enrollment Period (IEP)

Your Initial Enrollment Period is your first chance to enroll in Medicare Part B. It lasts seven months — beginning three months before, including your birth month, and continuing three months after you turn 65.

• If you enroll before your birthday month, your Part B coverage starts the month you turn 65.
• If you enroll during or after your birthday month, coverage begins the month after you enroll.

Tip: Even if you’re still working, check with your employer’s HR department to see whether you should enroll right away or delay Part B to avoid duplicate coverage.

Special Enrollment Period (SEP)

If you or your spouse are still working past 65 and have employer-sponsored health coverage, you can delay enrolling in Part B without penalty. Once that coverage ends, you qualify for a Special Enrollment Period.

The SEP lasts eight months from the date your employment or group coverage ends — whichever comes first. Enrolling during this window ensures you don’t face the Part B late enrollment penalty, which can increase your premium by 10% for every 12 months you were eligible but didn’t sign up.

Important: COBRA or retiree coverage doesn’t count as active employer coverage, so your SEP clock may start ticking sooner than you think.

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General Enrollment Period (GEP)

If you missed both your Initial and Special Enrollment Periods, the General Enrollment Period gives you another chance. The GEP runs every year from January 1 to March 31.

• Coverage begins the first day of the month after you enroll.
• You may owe a late enrollment penalty added to your monthly premium for as long as you have Part B.

While this period can be a helpful safety net, it’s best to avoid relying on it if possible due to potential penalties and delayed coverage.

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Medicare Advantage (Part C) and Other Related Enrollment Periods

Once you have Part B, you can explore Medicare Advantage (Part C) or Medigap plans to supplement your coverage. Enrollment in these plans often depends on your Part B effective date, so timing your Part B enrollment correctly is crucial for coordinating your full Medicare coverage.

Understanding Medicare Part B enrollment periods can save you money and prevent headaches down the road. Whether you’re turning 65 soon, working past retirement age, or helping a loved one with their coverage decisions, planning ahead is key.

If you’re unsure when to enroll, a licensed Medicare agent can review your situation, explain your options, and help you avoid penalties or coverage gaps.

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Medicare Costs 2026: What Beneficiaries and Agents Need to Know

As Medicare undergoes significant shifts in 2026, beneficiaries will face new premiums, deductibles, and cost-sharing structures. These costs impact how they access and budget for care. For agents, understanding these changes is essential for guiding clients through enrollment decisions and helping them prepare for the year ahead. Here’s a breakdown of important Medicare cost updates for 2026 and what they mean for the people you serve.

Higher Costs Driven by Utilization and Program Changes

Several factors are driving cost increases across Medicare Part A and Part B in 2026:

• Greater healthcare utilization: Hospital and outpatient visits continue to rise.
• Higher reimbursement requirements: Centers for Medicare & Medicaid Services (CMS) is adjusting payments to hospitals, physicians, and Medicare Advantage plans due to inflation and increased care complexity.
• Changes in Medicare Advantage rules: Policy shifts for 2026; including tighter oversight and reduced supplemental benefit flexibility, are indirectly affecting Original Medicare spending trends.

While Medicare costs rise most years, 2026 brings a more noticeable increase driven by combined economic and regulatory pressures.

Medicare Part A Costs for 2026

Most beneficiaries still receive Part A with no monthly premium (if they qualify via work-history) but other Part A cost-sharing amounts are increasing:

• Inpatient hospital deductible (Part A): For 2026 the deductible for a benefit period is $1,736, up from $1,676 in 2025.
• Daily coinsurance for days 61–90 in hospital: $434 per day in 2026, up from $419.
• Lifetime reserve-day coinsurance: $868 per day in 2026.
• Skilled Nursing Facility (SNF) coinsurance (days 21-100): $217 per day in 2026, up from $209.50.

Agents should remind clients that even if Part A premium is “free,” they can still face significant out-of-pocket exposure via hospital stays and extended care—making Medigap or a well-selected Medicare Advantage plan even more important.

Medicare Part B Costs for 2026

Part B sees some of the most direct increases:

• Standard monthly premium (Part B): $202.90 per month in 2026 (up from $185.00 in 2025).
• Annual deductible (Part B): $283 in 2026 (up from $257 in 2025).
• Income-related monthly adjustment amounts (IRMAA): Beneficiaries with higher incomes will pay more than the standard premium; for 2026 the standard premium applies to individuals with a modified adjusted gross income (MAGI) up to $109,000 (or $218,000 for joint filers)

For agents, breaking down these numbers early in AEP and during SEP conversations helps clients avoid sticker-shock and budget accurately.

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Prescription Drug Costs

• The annual deductible for the standard Part D benefit in 2026 is $615.
• Beneficiaries will pay cost-sharing (typically coinsurance) during the initial coverage phase until their true out-of-pocket (TrOOP) drug spending hits $2,100 for 2026. At that point, the plan pays 100% of covered drugs for the rest of the year.
• All 2026 Part D plans are required to include this $2,100 cap.
• For beneficiaries with very high drug costs, this cap provides meaningful protection, limiting their maximum annual out-of-pocket prescription drug expense (excluding premiums).

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Medicare costs are rising in 2026; with thoughtful planning, beneficiaries and their agents can manage these changes with confidence. By staying informed and proactively communicating updates, agents stand out as trusted, knowledgeable guides.

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Medicare A and B Basics

Understanding Medicare can feel overwhelming at first, but it becomes much simpler once you break it down into the two core parts of Original Medicare: Part A and Part B. These two components form the foundation of Medicare coverage and help beneficiaries access essential hospital and medical care. Whether you’re approaching age 65 or helping a loved one navigate enrollment, here’s the Medicare A and B Basics.

What Medicare Part A Covers (Hospital Insurance)

Medicare Part A is often called hospital insurance because it helps cover care you receive in a hospital or similar inpatient setting. Most people receive Part A premium-free as long as they or their spouse worked and paid Medicare taxes for at least 10 years.

Part A covers:

Inpatient Hospital Care

This includes semi-private rooms, meals, nursing care, medications given in the hospital, and other hospital services. Part A does not cover private rooms unless medically necessary.

Skilled Nursing Facility (SNF) Care

Part A may cover care in a skilled nursing facility after a qualifying three-day inpatient hospital stay. This is not long-term custodial care, but medically necessary rehabilitation services such as physical or occupational therapy.

Home Health Care

If ordered by a doctor and medically necessary, Part A can help cover intermittent skilled nursing care, physical therapy, or speech therapy delivered in the home.

Hospice Care

For patients with a terminal illness and a prognosis of six months or less, Part A provides comprehensive hospice benefits, including pain relief, symptom management, and family support.

Part A Costs

Most beneficiaries pay no monthly premium, but deductibles and coinsurance still apply. For example, there is a per-benefit-period deductible for hospital stays and daily coinsurance after certain lengths of inpatient care.

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What Medicare Part B Covers (Medical Insurance)

Medicare Part B is medical insurance that covers outpatient and physician services. Unlike Part A, everyone pays a monthly premium for Part B, and higher-income beneficiaries may pay more.

Part B covers:

Doctor Visits

This includes primary care, specialists, and certain preventive screenings and exams.

Outpatient Services

Such as X-rays, lab work, outpatient surgeries, and emergency room or urgent care services (when not admitted as an inpatient).

Durable Medical Equipment (DME)

Items like walkers, wheelchairs, CPAP machines, and home oxygen equipment.

Preventive Care

Medicare Part B provides a wide range of preventive services at no extra cost when using participating providers; annual wellness visits, vaccines, mammograms, colonoscopies, and more.

Mental Health Services

Includes outpatient therapy, psychiatric evaluations, and some partial hospitalization programs.

Part B Costs

Beneficiaries pay a standard monthly premium, an annual deductible, and typically 20% coinsurance for most covered services. Part B has no out-of-pocket maximum unless you pair it with a Medigap plan or choose a Medicare Advantage plan.

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How Medicare A & B Work Together

Part A and Part B complement each other to provide broad medical coverage. Part A focuses on inpatient care, while Part B handles outpatient and ongoing medical needs. Many people choose to add:

• A Medicare Supplement (Medigap) to reduce out-of-pocket costs
• A Part D prescription drug plan
• Or a Medicare Advantage plan that bundles A, B, and often D into one

Your choice depends on your budget, health needs, and preferred style of coverage.

Understanding the basics of Medicare Parts A and B is the first step in building reliable coverage for your healthcare needs. By knowing what each part covers and what it doesn’t; you can make confident decisions as you prepare for enrollment or compare additional coverage options

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Medicaid and Long-Term Care

When it comes to paying for long-term care, many families are surprised to learn that Medicare doesn’t cover most long-term care costs. That’s where Medicaid can step in as a vital resource. For seniors and individuals with limited income and assets, Medicaid can help cover the high cost of nursing home care and, in some cases, in-home or assisted living services. However, the rules can be complex and understanding how Medicaid and long-term care work together can be important to planning ahead.

Medicaid coverage of Long-Term Care

Medicaid is a joint federal and state program that helps people with low income and limited resources pay for healthcare. One of its most important benefits is coverage for long-term care services, such as:

• Nursing home care (room, meals, skilled nursing, and personal care)
• Home and community-based services (HCBS) like in-home aides, adult day care, or home modifications
• Assisted living services in some states

Because Medicaid is managed by each state within federal guidelines, coverage details and eligibility requirements vary depending on where you live.

Financial Eligibility: Income and Asset Limits

To qualify for Medicaid long-term care, applicants must meet strict financial and functional requirements.

Most states have both:

• Income limits — based on a percentage of the federal poverty level or a fixed monthly cap.
• Asset limits — typically allowing applicants to keep only a small amount in countable resources (often around $2,000 for an individual).

However, not all assets are counted. For example, your primary residence (up to a certain equity limit), one vehicle, personal belongings, and certain burial funds may be excluded.

Couples have special rules called “spousal impoverishment protections”, which allow the healthy spouse to retain a portion of income and assets so they are not left destitute.

Functional Eligibility: Level of Care Requirements

In addition to financial need, applicants must demonstrate a medical need for long-term care. Each state has criteria to determine whether a person requires nursing home level of care; such as needing assistance with multiple daily activities (bathing, dressing, eating, toileting, or mobility).

Medicaid Estate Recovery

It’s important to note that Medicaid can seek repayment for long-term care costs from the estate of the deceased beneficiary. This process, called estate recovery, generally occurs after the recipient’s death, often through the sale of property or assets left behind. However, exceptions and delays may apply if there’s a surviving spouse or dependent child.

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Home and Community-Based Waivers (HCBS)

Many states now offer Medicaid waivers that allow people to receive care at home or in community settings rather than in nursing homes. These programs help individuals remain as independent as possible while still receiving support services. Waiver programs often have limited slots and waiting lists, so early planning is essential.

The Importance of Planning Ahead

Medicaid long-term care planning can be complex; involving income limits, asset transfers, and look-back periods (typically five years). Attempting to give away assets or transfer property before applying can trigger penalty periods of ineligibility.

Working with a qualified elder law attorney or Medicaid planning specialist can help families understand their options, protect assets legally, and prepare for future care needs.

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Medicaid is a lifeline for many Americans who need long-term care but cannot afford it privately. By understanding the program’s eligibility rules, coverage options, and planning strategies, families can make informed decisions that protect both their health and their financial well-being.

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Understanding Medicare Part D Coverage

Medicare Part D is the portion of Medicare that helps pay for prescription drugs, providing essential coverage for those who rely on medication. While Part D plans differ, they all follow general Medicare guidelines. This makes understanding Medicare Part D coverage a little easier. Here’s a breakdown of what Part D covers, and what it does not cover, to help avoid surprises at the pharmacy.

What Medicare Part D Covers

Medicare Part D plans are offered by private insurance companies, and each plan has its own formulary, or list of covered medications. Still, all plans must include a wide range of commonly used prescription drugs.

Retail and Mail-Order Prescriptions

Part D primarily covers medications you pick up at a pharmacy or receive through mail-order. Drugs are grouped into tiers, which determine your copay or coinsurance.

Essential Drug Classes

Plans must include at least 1 medication in each key category such as:

• Antidepressants
• Antipsychotics
• Immunosuppressants
• HIV/AIDS medications
• Anticonvulsants
• Some oral cancer drugs not covered by Part B

Certain Vaccines

Part D pays for vaccines not covered by Part B, including the shingles vaccine.

Insulin and Related Supplies

Many plans have capped insulin costs and cover supplies like needles and syringes.

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What Medicare Part D Does Not Cover

While Part D covers many prescriptions, several important exclusions apply.

Drugs Given in a Hospital

If you’re admitted as an inpatient, medications provided during your stay are covered under Medicare Part A, not Part D.

Medications Administered in a Doctor’s Office

Any drug that must be given by a healthcare professional; such as injections, infusions, or biologics, is usually covered under Medicare Part B.

Examples include:

• IV antibiotics
• Chemotherapy infusions
• Injectable osteoporosis treatments

Over-the-Counter Products

Part D does not cover vitamins, supplements, or OTC medications unless a plan offers them as an added benefit.

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Cosmetic and Weight-Loss Medications

Most drugs used for cosmetic purposes or weight reduction are excluded.

Non-Formulary Drugs

If a drug isn’t listed on a plan’s formulary, it generally won’t be covered unless your doctor requests and the plan approves a formulary exception.

Experimental Drugs

Any medication that is not FDA-approved is excluded.

Medicare Part D is a valuable benefit, but understanding what it covers and doesn’t, helps you choose the right plan and avoid unexpected costs. Reviewing formularies and pharmacy networks each year ensures you get the most from your prescription drug coverage.

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