Does Medicare Cover Aldactone?
This article was updated on: 09/10/2018
What is Aldactone?
Doctors may prescribe Aldactone to help treat people with hyperaldosteronism, reports the National Institutes of Health’s Medline Plus website. This is the name for a condition where the body produces too much of a hormone called aldosterone. Aldactone might also be prescribed for health issues such as high blood pressure, heart failure, low potassium levels, or edema (fluid buildup). Aldactone, the brand name for the generic drug spironolactone, is not usually covered by Original Medicare, Part A and Part B except in certain situations; read on for more details.
How does Medicare coverage for Aldactone work?
If you take Aldactone at home, neither Medicare Part A nor Part B is likely to cover it. Part A typically covers medications given to you as part of your treatment as a hospital inpatient. If a health-care provider administers medications to you in an outpatient setting, like a clinic, Part B may cover them.
Generally Medicare prescription drug coverage for medications such as Aldactone is available through the Medicare Part D program. Medicare Part D Prescription Drug Plans are offered by private health insurance companies approved by Medicare to provide these benefits. Some of these plans may cover Aldactone.
Medicare prescription drug coverage is voluntary, whether you take Aldactone or other prescriptions, but you may want enroll in a plan as soon as you become eligible for Medicare. That way you may avoid paying a permanent late-enrollment penalty with your monthly premium if you ever do decide to enroll. That is – if you don’t sign up for Medicare prescription drug coverage as soon as you qualify for Medicare, and then you add this coverage later on, you could pay a late-enrollment penalty.
How might I get Medicare coverage for Aldactone?
If your doctor prescribes Aldactone, or other medications, you might want to look into prescription drug coverage under Medicare Part D. You can get Medicare coverage for prescription drugs in either of two ways:
- As a stand-alone Medicare Part D Prescription Drug Plan that works with your Original Medicare (Part A and Part B) coverage (or certain other types of Medicare health plans)
- As part of a Medicare Advantage Prescription Drug plan
Both of these plan options are offered by private, Medicare-approved insurance companies. With either type of plan, you need to live within the plan’s service area. Note that some plans might not cover Aldactone.
The Medicare Advantage (Medicare Part C) program gives you an alternative way to get your Medicare benefits in one convenient plan; by law, they must cover everything that Original Medicare (Part A and Part B) covers — except for hospice care, which is still covered under Part A. Most Medicare Advantage plans include prescription drug coverage, and some plans offer extra benefits to members, including coverage for routine vision and dental care, and fitness programs. You do have to continue paying your Part B premium, in addition to any required plan premium, if you enroll in a Medicare Advantage plan. Some Medicare Advantage plans may cover Aldactone.
If you take Aldactone or other prescription medications on a daily basis, you might want to see if you have Aldactone coverage in your plan’s formulary. Each Medicare plan with prescription drug coverage has its own formulary, or list of covered medications.
You can use the Find Plans tool on this page to find plans that cover Aldactone or its generic equivalent, spironolactone. You should note, however, that plans may change their formularies occasionally; you will receive notice from your plan when necessary.
Not all plan types and plan benefits may be available in every location, and plan premiums may vary. You may have different deductibles, copayments, and coinsurance amounts depending on the plan you select.
How can I decide which plan to choose to cover Aldactone?
Only you can decide which might work for you: Original Medicare with a stand-alone Medicare Part D Prescription Drug Plan, or a Medicare Advantage Prescription Drug plan – and which of the available plans you prefer.
If you’d like help evaluating your Medicare Advantage and stand-alone Medicare Part D Prescription Drug Plan options — and your out-of-pocket costs with each for spironolactone or Aldactone and other health-care needs — I’m available to answer your questions. You can request information via email or schedule a phone call at your convenience by clicking one of the links below. To see a list of plans in your area that you may qualify for, click the Compare Plans or Find Plans button.