Medicare FAQ

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Frequently Asked Questions

Browse answers to the most common Medicare questions — organized, interactive, and powered by May River Medicare’s advanced technology. Use the search bar below to instantly filter through our nationwide FAQ library.

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What is Medicare and how does it work?

What are the different parts of Medicare?

When am I eligible for Medicare?

Do I need to enroll in Medicare if I’m still working?

What is Medicare Part A?

What is Medicare Part B?

What is Medicare Part C (Medicare Advantage)?

What is Medicare Part D?

What is Medigap (Medicare Supplement)?

Do I need a Part D drug plan?

Does Medicare cover dental, vision, or hearing?

Difference between Medicare Advantage & Medigap?

How do Medicare Advantage plans work?

What is the Initial Enrollment Period?

What is the Annual Enrollment Period?

What is Medicare Advantage Open Enrollment?

What is a Special Enrollment Period?

Does Medicare have penalties?

How much does Medicare cost?

What if I can’t afford Medicare?

Does Medicare cover my doctor or hospital?

What is a Medicare network?

What is a formulary for Part D drug plans?

Are Medicare Advantage plans free?

Why do Medicare Advantage plans have different copays?

Do all pharmacies charge the same price for medications?

What is the Medicare Part B late enrollment penalty?

What is the Part D late enrollment penalty?

How do I avoid Medicare penalties?

Does Medicare cover pre-existing conditions?

Can I change Medicare plans anytime?

Can I have Medicare and employer insurance at the same time?

How do I know if my medications are covered?

What is Extra Help (LIS) for prescription costs?

What is a Dual Eligible plan (Medicare + Medicaid)?

What is the Medicare Savings Program?

What is the “Donut Hole” in Part D?

Does Medicare cover cancer treatment?

Does Medicare cover emergency care outside the U.S.?

Can I use Medicare anywhere in the country?

How do I get Medicare if I’m disabled?

Does Medicare cover home health care?

Does Medicare cover nursing homes or long-term care?

Does Medicare cover physical therapy?

How do Medicare copays and deductibles work?

What is the Medicare Out-of-Pocket Maximum?

Are Medicare Advantage plans required to cover everything Original Medicare covers?

What does Medicare NOT cover?

Does Medicare cover routine checkups?

Does Medicare cover mental health services?

Does Medicare cover chiropractic care?

Does Medicare cover emergency ambulance services?

Does Medicare cover telehealth?

How do I enroll in Medicare for the first time?

Can I enroll online without speaking to an agent?

How long does Medicare enrollment take?

What documents do I need for Medicare enrollment?

Can I switch from Medicare Advantage back to Original Medicare?

Can I switch Medicare Supplement plans?

How often can I change my Part D drug plan?

Does Medicare cover durable medical equipment (DME)?

Does Medicare cover diabetes supplies?

Does Medicare cover kidney dialysis?

Does Medicare cover vaccines?

Does Medicare cover mammograms and cancer screenings?

How do Medicare referrals work?

What happens if my doctor doesn’t accept Medicare?

What happens if my Medicare Advantage plan changes?

Are Medicare Advantage benefits guaranteed every year?

How do provider networks work with Medicare Advantage?

What happens if my prescriptions change during the year?

Why do drug plans have different tiers and copays?

What pharmacies are preferred in Part D plans?

How does May River Medicare help compare plans?

How does the May River Medicare quote tool work?

Why do you need my ZIP code for accurate quotes?

How do I book an appointment with a licensed Medicare agent?

Do you have a mobile app for Medicare quotes?

Can I enroll online through your website?

How do I start the Preliminary E-Application?

What is Medicare and how does it work?

Medicare is a federal health insurance program for people 65+ or under 65 with certain disabilities. It includes Parts A, B, C, and D, each covering different services.

Want personalized guidance?
Speak with a licensed advisor.

What are the different parts of Medicare?

Medicare includes:
• Part A – Hospital coverage
• Part B – Medical coverage
• Part C – Medicare Advantage
• Part D – Prescription drug coverage

Need help choosing coverage?
Use the app.

When am I eligible for Medicare?

Most people become eligible at age 65. Some qualify earlier due to disability, ALS, or ESRD.

Want us to confirm your eligibility?
Schedule a call.

Do I need to enroll in Medicare if I’m still working?

It depends on your employer size and whether your coverage is creditable. Many people delay Part B penalty-free if they have large employer coverage.

Need to confirm your situation?
We can help.

What is Medicare Part A?

Medicare Part A covers inpatient hospital stays, skilled nursing, hospice care, and some home health care.

Need to check Part A eligibility?
Talk to an advisor.

What is Medicare Part B?

Part B covers outpatient care, doctor visits, tests, durable medical equipment, and preventive services.

Want cost details for Part B?
Check in the app.

What is Medicare Part C (Medicare Advantage)?

Part C bundles Parts A & B and often Part D into one plan with extra benefits like dental and vision.

Compare Advantage plans:
Download the app.

What is Medicare Part D?

Part D provides prescription drug coverage through private insurance companies.

Check drug coverage instantly:
Use the app.

What is Medigap (Medicare Supplement)?

Medigap helps pay deductibles, copays, and coinsurance not covered by Original Medicare.

Compare Medigap rates:
Check plans.

Do I need a Part D drug plan?

If you take medications, yes — skipping Part D may result in a permanent penalty.

Compare drug plans easily:
Open the app.

Does Medicare cover dental, vision, or hearing?

Original Medicare does not cover routine dental, vision, or hearing. Many Advantage plans include these benefits.

Compare benefits now:
Download the app.

Difference between Medicare Advantage & Medigap?

Advantage = lower premiums, network restrictions. Medigap = higher premiums, nationwide usage, fewer out-of-pocket costs.

Not sure which fits you?
Talk with an advisor.

How do Medicare Advantage plans work?

Advantage plans replace Original Medicare and often include prescription drug coverage, dental, vision, and more.

See plans in your ZIP:
Use the app.

What is the Initial Enrollment Period?

The Initial Enrollment Period is a 7-month window surrounding your 65th birthday when you can first enroll in Medicare.

Need help timing your enrollment?
Speak with a specialist.

What is the Annual Enrollment Period?

The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year. During AEP, you can change Medicare Advantage or Part D plans for the upcoming year.

Review your options early using the mobile app.

What is Medicare Advantage Open Enrollment?

This period runs from January 1 to March 31. You can switch Medicare Advantage plans or go back to Original Medicare (with or without Part D).

Not sure which option is best? Talk to a licensed advisor.

What is a Special Enrollment Period?

A Special Enrollment Period (SEP) allows you to make Medicare changes outside normal enrollment periods due to life events like moving, losing employer coverage, or qualifying for Medicaid.

Need to verify your SEP eligibility? Book a consultation.

Does Medicare have penalties?

Yes — late enrollment penalties may apply for Part B and Part D if you delay without creditable coverage. These penalties can last for life.

Avoid penalties by connecting with an advisor: Schedule Now.

How much does Medicare cost?

Medicare costs vary based on income, plan type, and medication needs. Many people pay $0 for Part A but must pay a premium for Part B and sometimes Part D.

Get exact pricing for your ZIP code using the mobile app.

What if I can’t afford Medicare?

Programs like Medicaid, Extra Help (LIS), and Medicare Savings Programs can lower or eliminate Medicare costs. Many seniors qualify without knowing it.

Check eligibility with our advisors: Book Appointment.

Does Medicare cover my doctor or hospital?

Medicare covers most doctors and hospitals that accept Medicare assignment. Medicare Advantage plans may have network restrictions depending on your county and ZIP code.

Check if your doctor is covered: Schedule a review.

What is a Medicare network?

A network refers to doctors, hospitals, and healthcare providers contracted with your Medicare Advantage plan. PPO plans offer more flexibility than HMO plans.

Verify networks instantly in our mobile app.

What is a formulary for Part D drug plans?

A formulary is the list of medications a Part D plan covers. Drugs are organized into tiers that determine cost.

Search your prescriptions instantly in the May River Medicare App.

Are Medicare Advantage plans free?

Some Medicare Advantage plans have a $0 premium, but all plans still have cost-sharing such as copays, deductibles, and a maximum out-of-pocket limit.

Compare premium-free plans in your area through our mobile app.

Why do Medicare Advantage plans have different copays?

Copays vary because Advantage plans are run by private companies. Different plan structures, networks, and benefits affect costs.

See side-by-side comparisons: Book a consultation.

Do all pharmacies charge the same price for medications?

No — preferred pharmacies typically offer lower copays, and prices can differ significantly even within the same plan.

Use our app to compare pharmacy prices instantly: Download here.

What is the Medicare Part B late enrollment penalty?

If you delay Part B without creditable coverage, your premium may increase 10% for each full year you delay — for life.

Avoid penalties by consulting an advisor: Schedule now.

What is the Part D late enrollment penalty?

If you delay enrolling in drug coverage without creditable coverage, you may pay a permanent penalty based on the number of months you delayed.

Need help determining if your coverage is creditable?
We can help.

How do I avoid Medicare penalties?

Enroll on time or ensure your employer coverage is creditable. Missing deadlines is the #1 cause of lifetime penalties.

Avoid mistakes by connecting with an advisor: Book now.

Does Medicare cover pre-existing conditions?

Yes — Medicare covers all pre-existing conditions. Medicare Supplement (Medigap) plans may require underwriting unless you enroll during your guaranteed issue period.

Need GI guidance? Schedule a review.

Can I change Medicare plans anytime?

Some changes require specific enrollment periods, but others can be made through Special Enrollment Periods depending on your situation.

Check your eligibility: Talk to an advisor.

Can I have Medicare and employer insurance at the same time?

Yes — Medicare can coordinate with employer coverage depending on employer size. This may allow penalty-free delays for Part B.

Unsure how your coverage coordinates? We can review it.

How do I know if my medications are covered?

Coverage varies by plan and formulary. You MUST check your exact medications each year.

Use our instant drug checker: Download App.

What is Extra Help (LIS) for prescription costs?

Extra Help reduces your Part D premiums, deductibles, and medication copays — sometimes to as low as $0.

Find out if you qualify: Get evaluated.

What is a Dual Eligible plan (Medicare + Medicaid)?

Dual Eligible Special Needs Plans (D-SNPs) provide enhanced benefits for those who qualify for both Medicare and Medicaid.

Want to see if you qualify? Speak with a specialist.

What is the Medicare Savings Program?

This program helps pay Medicare premiums and sometimes deductibles and coinsurance. Many people qualify without knowing it.

Check your eligibility quickly: Start here.

What is the “Donut Hole” in Part D?

The Donut Hole is a temporary limit on what a Part D plan will cover for medications. Once you reach the limit, your cost-sharing changes until you reach catastrophic coverage.

Track drug spending accurately in our mobile app.

Does Medicare cover cancer treatment?

Yes — Medicare covers chemotherapy, radiation, surgeries, medications, and diagnostic imaging. Medicare Advantage plans may require authorizations.

Verify your coverage: Speak to an advisor.

Does Medicare cover emergency care outside the U.S.?

Original Medicare does not cover most foreign travel medical emergencies, but some Medigap plans provide limited international emergency coverage.

Need coverage before traveling? Get help now.

Can I use Medicare anywhere in the country?

Original Medicare can be used nationwide with any provider that accepts Medicare. Medicare Advantage plans may restrict you to local networks depending on the plan type.

Want to confirm your coverage? Schedule a review.

How do I get Medicare if I’m disabled?

People who receive Social Security Disability (SSDI) benefits automatically qualify for Medicare after 24 months of disability payments. Those with ALS or ESRD may qualify sooner.

Need assistance? We can help.

Does Medicare cover home health care?

Yes — Medicare covers skilled nursing, physical therapy, occupational therapy, and certain home health services when medically necessary and ordered by a doctor.

Verify eligibility: Talk to an advisor.

Does Medicare cover nursing homes or long-term care?

Medicare does NOT cover most long-term custodial care. It does cover medically necessary skilled nursing care for a limited time after a qualifying hospital stay.

For long-term planning, speak with an advisor.

Does Medicare cover physical therapy?

Yes — Medicare Part B covers medically necessary outpatient physical therapy. Medicare Advantage plans may require preauthorization.

Need help confirming coverage? Schedule a call.

How do Medicare copays and deductibles work?

Medicare has standardized deductibles and cost-sharing that change yearly. Medicare Advantage plans set their own copays but must follow Medicare regulations.

See your updated costs in the mobile app.

What is the Medicare Out-of-Pocket Maximum?

Original Medicare has no out-of-pocket maximum. Medicare Advantage plans include an annual cap on what you pay for covered services.

Check MOOP limits in your ZIP code using the app.

Are Medicare Advantage plans required to cover everything Original Medicare covers?

Yes — Medicare Advantage must cover all services that Original Medicare covers. They may add extras like dental, vision, hearing, and more.

Compare Advantage plans in seconds: Download Now.

What does Medicare NOT cover?

Medicare does not cover:
• Routine dental, vision, or hearing
• Long-term care
• Most cosmetic surgery
• Routine foot care
• Hearing aids (Original Medicare)

Some Advantage plans cover these extras. Check benefits in your ZIP code using the app.

Does Medicare cover routine checkups?

Medicare covers an annual wellness visit and several preventive services. Routine physicals are not fully covered under Original Medicare.

Check preventive coverage details: Speak to an advisor.

Does Medicare cover mental health services?

Yes — Medicare covers therapy, counseling, psychiatric evaluation, and inpatient mental health services. Copays vary depending on plan type.

Need coverage guidance? Schedule a call.

Does Medicare cover chiropractic care?

Medicare covers medically necessary chiropractic adjustments for spinal subluxation under Part B. Other chiropractic services are not covered.

Need confirmation? Let us verify.

Does Medicare cover emergency ambulance services?

Yes — Medicare Part B covers medically necessary ambulance transportation. Some Medicare Advantage plans may have different copays or rules.

Need more info? Ask an advisor.

Does Medicare cover telehealth?

Yes — Medicare expanded telehealth coverage for doctor visits, mental health services, and more. Medicare Advantage plans may offer additional telehealth benefits.

Confirm plan details in our mobile app.

How do I enroll in Medicare for the first time?

You can enroll through Social Security, online, by phone, or in person. Enrollment timing depends on your employment status and eligibility.

For guided help: schedule a call.

Can I enroll online without speaking to an agent?

Absolutely — you can use May River Medicare’s secure online tools to compare plans and self-enroll anytime, 24/7.

Start here:
Preliminary E-Application.

How long does Medicare enrollment take?

It typically takes 2–4 weeks for your Medicare card to arrive after signing up. Some cases may take longer depending on Social Security processing.

Need faster plan comparisons? Download the app.

What documents do I need for Medicare enrollment?

You may need:
• Social Security number
• Proof of age
• Citizenship or residency documents
• Employer coverage forms (if delaying Part B)

Want help reviewing documents?
Talk to us.

Can I switch from Medicare Advantage back to Original Medicare?

Yes — you can switch during AEP or Medicare Advantage Open Enrollment. You may also need a Part D plan and possibly Medigap underwriting.

Need switching guidance? We can help.

Can I switch Medicare Supplement plans?

Yes — but some changes may require medical underwriting unless you’re in a guaranteed-issue window.

Verify your eligibility: Schedule now.

How often can I change my Part D drug plan?

You can change Part D plans during AEP each year (Oct 15–Dec 7). Special Enrollment Periods may allow changes outside AEP.

Review your drug plan options: Use the app.

Does Medicare cover durable medical equipment (DME)?

Yes — Medicare Part B covers durable medical equipment such as wheelchairs, walkers, CPAP machines, oxygen equipment, and more when medically necessary.

Need help verifying DME coverage?
Talk with an advisor.

Does Medicare cover diabetes supplies?

Medicare Part B covers diabetic testing supplies, insulin pumps, and screenings. Medicare Part D covers insulin and certain medications.

Compare medication costs instantly in our mobile app.

Does Medicare cover kidney dialysis?

Yes — Medicare covers dialysis treatments, kidney-related medications, and transplant care for people with ESRD (End-Stage Renal Disease).

Need help choosing an ESRD-friendly plan?
Speak with an expert.

Does Medicare cover vaccines?

Yes — Medicare covers all ACIP-recommended vaccines including flu, COVID-19, pneumonia, shingles, and more under Part D or Part B depending on the vaccine.

Verify vaccine coverage:
Use the app.

Does Medicare cover mammograms and cancer screenings?

Yes — Medicare covers mammograms, colonoscopies, lung cancer screening, prostate exams, and more as part of preventive care.

Need screening schedule guidance?
Talk to an advisor.

How do Medicare referrals work?

With Original Medicare, referrals are generally not required. Medicare Advantage HMO plans often require referrals for specialists.

Want to confirm your plan’s rules?
Ask us.

What happens if my doctor doesn’t accept Medicare?

If your doctor doesn’t accept Medicare assignment, you may pay more out-of-pocket. Some Medicare Advantage plans require in-network doctors only.

Confirm your doctor’s status:
We can check for you.

What happens if my Medicare Advantage plan changes?

Plans may change premiums, copays, drug formularies, and provider networks each year. AEP (Oct 15–Dec 7) lets you switch if needed.

Compare changes easily:
Use our app.

Are Medicare Advantage benefits guaranteed every year?

No — Advantage plans can change benefits, networks, and drug lists annually. Always review your Annual Notice of Change (ANOC).

Need help reviewing changes?
We’re here to help.

How do provider networks work with Medicare Advantage?

Networks determine which doctors and hospitals you can use. HMO = must use in-network, PPO = more flexibility.

Check your doctor’s network status in seconds:
Download app.

What happens if my prescriptions change during the year?

Costs can change if the medication isn’t in your plan’s formulary or its tier differs. Some exceptions and appeals may apply.

Check drug coverage instantly:
Use the app.

Why do drug plans have different tiers and copays?

Medications are grouped into tiers — generics cost less, brand names cost more. Plans negotiate different prices with manufacturers.

Compare drug prices easily:
Download App.

What pharmacies are preferred in Part D plans?

Preferred pharmacies have lower copays and better pricing. Each plan has its own preferred pharmacy list.

Find the cheapest pharmacy instantly:
Use our app.

How does May River Medicare help compare plans?

We provide unbiased comparisons of Medicare Advantage, Medigap, and Part D plans based on your county, ZIP code, doctors, medications, and budget.

Start comparing instantly:
Download.

How does the May River Medicare quote tool work?

Our technology delivers instant Medicare quotes from all major carriers in your county and ZIP code — from lowest to highest pricing.

Try it now:
Open the App.

Why do you need my ZIP code for accurate quotes?

Medicare plan pricing is based on location — county and ZIP code determine premiums, networks, and available plans.

Get accurate quotes instantly:
Download the app.

How do I book an appointment with a licensed Medicare agent?

Booking is easy — use our online scheduling calendar to choose a time that works for you.

Book Appointment Now
or download our mobile app.

Do you have a mobile app for Medicare quotes?

Yes — the May River Medicare app delivers instant quotes, plan comparisons, and doctor/pharmacy lookup tools for all 50 states.

Download here:
Mobile App Download Page.

Can I enroll online through your website?

Yes — May River Medicare provides a secure online enrollment platform where you can compare and enroll in Medicare plans 24/7.

Start enrollment:
Preliminary E-Application.

How do I start the Preliminary E-Application?

You can start your Medicare enrollment online through our secure, guided E-Application process. It walks you through every step and submits your information safely.

Begin here:
Start E-Application.
May River Medicare - Complete Drug Coverage Intelligence

May River Medicare
Drug Coverage Intelligence

Complete A–Z Drug Library • Search by Name or Symptoms • ZIP-Accurate Coverage

Search Tips: Enter a medication name (e.g., "Metformin", "Eliquis") or describe your symptoms (e.g., "diabetes", "blood thinner", "heartburn", "joint pain"). Our intelligent search will show you how these medications are typically covered under Medicare.

Search by medication name or symptoms to see coverage information.

How Medicare Drug Coverage Really Works

Medicare drug coverage is not the same for everyone. The same medication can be covered, denied, or priced differently depending on how it is administered, which plan you choose, and where you live.

Covered Medications

Many generic and preventive drugs are covered early in the year. These are often low-cost and included across most plans.

Prices That Change

Some brand-name medications cost more early in the year until deductibles or coverage phases are reached. Costs often decrease later.

Denied Drugs

Some medications are excluded by Medicare law regardless of plan type. In these cases, alternatives may exist.

That's why May River Medicare shows you the intelligence first — before any calls, pressure, or enrollment.

Why Some Drugs Are Part B and Others Are Part D

Medicare Part B Drugs

These medications are typically administered by a medical professional in a clinic, hospital, or infusion center.

When paired with a Medicare Supplement, approved Part B drugs are often covered with little or no out-of-pocket cost.

Examples: Keytruda, Opdivo, Remicade, Rituxan

Medicare Part D Drugs

These medications are filled at a pharmacy and fall under prescription drug plans.

Costs may vary based on deductibles, coverage phases, and the specific plan design.

Examples: Metformin, Eliquis, Jardiance, Insulin

The same medication can be treated very differently depending on how it is administered.

Complete Medication Categories

Below are the most commonly prescribed medications for Medicare beneficiaries, organized by therapeutic category. Coverage varies by plan type, diagnosis, pharmacy network, and ZIP code.

Heart & Cardiovascular

  • Lisinopril
  • Amlodipine
  • Metoprolol
  • Atorvastatin
  • Rosuvastatin
  • Simvastatin
  • Eliquis (Apixaban)
  • Xarelto (Rivaroxaban)
  • Entresto
  • Carvedilol
  • Clopidogrel
  • Warfarin

Most are covered under Part D. Blood thinners may cost more early in the year until deductibles are met.

Diabetes

  • Metformin
  • Januvia
  • Jardiance
  • Farxiga
  • Ozempic (diabetes use)
  • Trulicity
  • Insulin (Lantus)
  • Insulin (Humalog)
  • Insulin (NovoLog)
  • Glipizide
  • Glyburide

Insulin pricing is federally capped. Other drugs vary by plan and deductible phase.

COPD & Asthma

  • Albuterol
  • Advair
  • Symbicort
  • Spiriva
  • Breo Ellipta
  • Fluticasone
  • ProAir
  • Ventolin

Inhalers are commonly covered under Part D with tier-based pricing.

Pain & Autoimmune

  • Humira
  • Enbrel
  • Gabapentin
  • Lyrica
  • Tramadol
  • Meloxicam
  • Celebrex
  • Prednisone

Specialty drugs may require prior authorization and specific plan design.

Neurology & Cognitive

  • Donepezil
  • Memantine
  • Levetiracetam
  • Carbidopa-Levodopa
  • Aricept
  • Namenda

Coverage depends on diagnosis and formulation. Generics are typically lower cost.

Mental Health

  • Sertraline
  • Escitalopram
  • Bupropion
  • Duloxetine
  • Quetiapine
  • Aripiprazole
  • Fluoxetine
  • Paroxetine
  • Venlafaxine

Many antidepressants are generic and widely covered under Part D.

Acid Reflux / GERD

  • Omeprazole
  • Pantoprazole
  • Famotidine
  • Esomeprazole
  • Lansoprazole
  • Ranitidine alternatives

Commonly covered as generics under Part D.

Cancer & Oncology

  • Keytruda
  • Opdivo
  • Imbruvica
  • Revlimid
  • Ibrance
  • Yervoy
  • Rituxan
  • Herceptin

Infusion drugs are usually billed under Part B. Oral therapies fall under Part D.

Thyroid & Hormones

  • Levothyroxine
  • Synthroid
  • Liothyronine
  • Armour Thyroid

Generic thyroid medications are widely available and typically low-cost.

Urological Health

  • Tamsulosin
  • Finasteride
  • Solifenacin
  • Tolterodine
  • Oxybutynin

Commonly covered under Part D for prostate and bladder health.

Blood Pressure

  • Losartan
  • Valsartan
  • Hydrochlorothiazide
  • Diltiazem
  • Norvasc
  • Clonidine

Generic blood pressure medications are among the most affordable under Medicare.

Common Exclusions

  • Wegovy
  • Zepbound
  • Mounjaro (weight loss use)
  • Cosmetic medications
  • Weight-loss drugs
  • Fertility treatments

These are excluded by Medicare statute regardless of plan type.

Exact coverage and pricing depend on your ZIP code — use our tools to confirm before enrolling.

Why Your State, County, and ZIP Code Matter

Medicare coverage is not one-size-fits-all. Drug pricing, formularies, and plan availability change based on where you live.

  • • Plans are approved at the county level
  • • Drug formularies vary by region
  • • Deductibles and copays differ by ZIP code
  • • Pharmacy networks change locally
  • • Prior authorization requirements vary by state
  • • Generic availability differs by region

That's why May River Medicare provides ZIP-accurate tools before enrollment.

When a Drug Is Denied — What Options Still Exist

A denial does not always mean the end of the road. Some medications are excluded by Medicare law, while others may have clinically equivalent alternatives that are covered.

Therapeutic Alternatives

In many cases, drugs within the same therapeutic class provide similar clinical outcomes and are covered under Medicare.

Diagnosis-Based Coverage

Coverage can change depending on the diagnosis associated with the prescription, especially for specialty medications.

Plan Structure Matters

Some plans exclude specific drugs while others may include them under different cost-sharing rules.

This is why comparing plans before enrolling is critical.

Ready to Confirm Your Coverage?

Drug coverage depends on your Medicare path, plan structure, and your state, county, and ZIP code. The tools below help you move from education to confirmation — without pressure.

Important Medicare Coverage Disclaimer

This prescription drug library is provided for educational purposes only. It does not guarantee coverage, pricing, approval, or eligibility for any medication.

  • • Medicare drug coverage varies by plan type, diagnosis, pharmacy network, and ZIP code
  • • Formularies, tiers, deductibles, and copays change annually
  • • Some drugs are excluded by Medicare statute regardless of plan selection
  • • Pricing may change throughout the year based on deductible and coverage phases
  • • Prior authorization and step therapy requirements vary by plan

May River Medicare does not provide medical advice. Always consult your physician and confirm coverage using ZIP-accurate tools or with a licensed Medicare advisor before enrolling.


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