Does Medicare Cover Avandia?
This article was updated on: 09/10/2018
If you have type 2 diabetes, your doctor might treat you with Avandia, or rosiglitazone (the drug’s generic name), along with diet and lifestyle changes and sometimes other medications. That’s according to the National Institutes of Health’s Medline Plus website. Generally, Original Medicare (Part A and Part B) doesn’t cover prescription drug therapy for diabetes, such as Avandia. Learn about coverage for Avandia under Medicare Part D below.
How do I get Medicare prescription drug coverage for Avandia?
There are two main ways to get coverage for Avandia (rosiglitazone) and other prescription drugs under the Medicare Part D program:
- You can enroll in a stand-alone Medicare Part D Prescription Drug Plan to complement your Original Medicare (Part A and Part B) benefits.
- You can enroll in a Medicare Advantage Prescription Drug plan, such as a Medicare Health Maintenance Organization (HMO) plan or a Preferred Provider Organization (PPO) plan.* You must continue to pay your Part B premium, plus any additional monthly premium required by your plan when you enroll in Medicare Advantage.
The plan options described above are available from private, Medicare-approved insurance companies. Not every plan type and optional benefit is available in every location, and plan benefits and premiums may vary depending on where you live.
Also keep in mind that not all plans cover the same set of prescription drugs. Every private insurance company contracted with Medicare to provide prescription drug coverage maintains its own formulary, or list of covered medications. If you take Avandia or rosiglitazone, you may want to check the formularies of the plans you’re considering to make sure it’s covered. Note that plans may change their formularies from time to time, but you will receive notice from your plan when necessary.
Please also note that deductibles, coinsurance amounts, and copayments may vary among plans. Also, you must live within a Medicare plan’s service area to be eligible to enroll in the plan, so you might want to use the Find Plans tool on this page to see what’s available in your vicinity.
When can I apply for Medicare prescription drug coverage for Avandia?
Generally, an ideal time to sign up for a Medicare plan that includes prescription drug coverage for drugs such as Avandia is when you’re first eligible for Medicare – during your Initial Enrollment Period. Although prescription drug coverage is optional, if you wait to enroll, you could face a late-enrollment penalty if you decide to enroll later on. Read about the other times you can sign up for a Medicare plan.
Which type of Medicare prescription drug coverage should I choose for Avandia?
This is a matter of personal preference as you look at the available plan options in your area.
Some beneficiaries prefer to get their Medicare Part A and Part B benefits through Medicare Advantage plans. Many Medicare Advantage plans include prescription drug coverage, and some plans also offer other benefits that may meet the health-care needs of diabetics, such as:
- Routine vision care and prescription eyewear
- Wellness programs to help you manage your weight
- Discounted gym memberships to help you reach your exercise goals
As a diabetic Medicare beneficiary, you might want to know about a special kind of Medicare Advantage plan, called a Special Needs Plan. These plans limit enrollment to individuals who meet certain criteria (such as diabetes), and have a formulary and menu of benefits specifically designed to meet the needs of plan enrollees.
You don’t lose any Medicare benefits when you enroll in a Medicare Advantage plan; by law, they must cover everything that’s included in Original Medicare, except for hospice care, which is still covered under Part A. Medicare Advantage is simply an alternative way to get your Medicare benefits, with the added convenience of having all your coverage, including prescription drug coverage, in one plan (if you enroll in a Medicare Advantage plan that includes this coverage).
If you decide to stay with Original Medicare, you can enroll in a stand-alone Medicare Part D Prescription Drug Plan alongside your Medicare Part A and Part B benefits. Another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.
Would you like more information about Medicare coverage for Avandia and other diabetes treatments? 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. To see a list of plans in your area, click the Compare Plans or the Find Plans button. You can also find out more about me by clicking the “View profile” link.
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.