Does Medicare Cover Ambien?
This article was updated on: 09/10/2018
What is Ambien?
Ambien is a prescription drug. The generic form of this medication is zolpidem.
What is Ambien used for?
Ambien is a prescription medication that is sometimes used to treat insomnia, according to the National Institutes of Health’s publication Medline Plus. Doctors sometimes prescribe drugs in a class called sedative-hypnotics, like Ambien, for sleeping problems on a short-term basis.
What is Ambien coverage under Original Medicare?
If you have Original Medicare, Part A and Part B, you might be wondering whether it covers Ambien. Under Original Medicare, prescription drug coverage is limited.
- Generally, Medicare Part A will cover any medications you get as part of your treatment during an inpatient hospital stay.
- You may be covered for medications that you receive as an outpatient (for example, at a clinic or in a doctor’s office) under Medicare Part B. Medications covered under Medicare Part B are usually prescription drugs that need to be given by a medical provider.
Since Ambien is mainly used for insomnia, and you’d normally take it at home, Medicare Part A and Part B wouldn’t usually cover it.
What is Ambien coverage under Medicare Part D?
If you take Ambien or other prescription drugs that may be used for various health conditions, you may be able to get these benefits under Medicare Part D, the prescription drug “part” of Medicare.
There are generally two ways to get Medicare prescription drug coverage. Typically you can get this coverage one way or the other, but not both.
- If you stay with Original Medicare (Part A and/or Part B), you can enroll in a stand-alone Medicare Part D Prescription Drug Plan.
- If you prefer to get your Medicare benefits through a Medicare Advantage plan, you can usually find one in your vicinity that covers prescription drugs. These are known as Medicare Advantage Prescription Drug plans.
Either type of plan might cover Ambien or zolpidem, but you may want to make sure before you enroll. To find out, you’ll need to check the plan’s drug formulary to determine if it covers Ambien. Every Medicare Prescription Drug Plan has a formulary, which is a list of the medications that the plan covers. Formularies can vary among plans and change from year to year, which is why it’s important to review your coverage every year and make sure your plan still covers all the medications you take. Although a plan’s formulary may change at any time, you will receive notice from your plan when necessary.
Keep in mind that Medicare Prescription Drug Plans may cover different medications and may have varying costs for those drugs. Shopping around might help you find a plan that covers Ambien and your other prescription drugs at a cost you can afford. If you’d like assistance looking for a Medicare plan that may cover the medications you need, I can help. I can discuss some of your Medicare plan options over the phone, or email you some customized recommendations; just use the links below to set that up. To start looking for Medicare Part D plans in your area, use the Compare Plans buttons on this page.