Does Medicare Cover Codeine?

Mike Olmos by Mike Olmos | Licensed since 2010

This article was updated on: 09/10/2018

What is Codeine?

Codeine is a narcotic pain reliever. It can also be used, in combination with other medications, to treat a cough. Narcotics like codeine treat pain by binding to receptors in the brain, blocking the sensation of pain, according to the U.S. National Library of Medicine. When used to treat coughing, codeine decreases the activity in the part of the brain that causes the cough. Prescription opioid drugs like codeine should only be used for severe pain that is not helped by other types of painkillers, according to the U.S. National Library of Medicine. Codeine can be habit-forming, and like other narcotics, can be associated with accidental overdose deaths reports the U.S. National Library of Medicine. Other types of narcotic pain relievers are morphine and fentanyl and Oxycontin.

Medicare Part A coverage of codeine

Medicare Part A may cover the prescription drugs like codeine you receive as an inpatient in a:

  • Acute care hospital
  • Critical access hospital
  • Inpatient rehabilitation facility
  • Long-term care hospital
  • Hospice care (Medicare may cover prescription medications for symptom control and pain relief)

Medicare Part B coverage of codeine

Medicare Part B will generally not cover prescription drugs that are self-administered. Medicare Part B may cover prescription drugs that you receive in a doctor’s office or outpatient setting, such as infusions or injections. Medicare Part B generally does not cover drugs you take by mouth, such as codeine, especially if you take it at home.

Medicare Part D coverage of codeine

To get coverage for codeine you take at home you generally need coverage in addition to Original Medicare, such as a stand-alone Medicare Part D Prescription Drug Plan offered by a private company. Check that your stand-alone Medicare Part D Prescription Drug Plan includes codeine in its formulary.  A formulary is a list of medications a plan will pay for and the benefits available for each. It also lists any special conditions, such as prior authorization, that apply to the medication. A plan may change its formulary at any time, but it will notify you in writing before any changes take place.

Medicare Part C coverage of codeine

An alternative way to get your Original Medicare (Part A and Part B) benefits is with Medicare Advantage, also called Medicare Part C. Medicare Advantage plans must cover everything Original Medicare covers, except hospice care, which is still covered by Part A. Medicare Advantage plans also often include extra benefits, such as prescription drug coverage. Like stand-alone prescription drug plans, Medicare Advantage prescription drug plans have formularies that list medications, such as codeine, that are covered. A plan may change its formulary at any time, but it will notify you in writing before any changes take place.

Stand-alone Part D Prescription Drug Plans cannot be combined with most types of Medicare Advantage plans.

I’m available to help you with any questions you may have about Medicare coverage of codeine and other prescription medications. 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 that you may qualify for, click the Compare Plans or Find Plans buttons.

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