Does Medicare Cover DiaBeta?
This article was updated on: 09/10/2018
Medicare Part A and Part B, which make up Original Medicare, generally don’t cover the prescription medication DiaBeta or its generic form, glyburide. The National Institutes of Health’s Medline Plus website says DiaBeta might be part of a treatment program for those with type 2 diabetes, along with a diet and exercise program and possibly other medications.
Keep reading below to learn more about DiaBeta and the Medicare plan options that may cover it.
Learn about Medicare coverage plans
To help you understand Medicare coverage of prescription drugs such as DiaBeta (glyburide), here’s some background about each part of Medicare and what it covers.
Medicare Part A is sometimes called “hospital insurance.” That’s because Part A typically covers inpatient hospital care; skilled nursing facilities care; hospice care; limited home health care; and certain other services. Part A would not generally cover your glyburide unless it was given to you as part of your treatment as a hospital inpatient.
Medicare Part B is sometimes called “medical insurance.” Part B typically covers your outpatient care, such as doctor appointments; physical therapy; some tests and screenings; certain medical equipment and supplies; and some home health care. Generally, Part B may cover specific prescription drugs administered to you as an outpatient – but it doesn’t typically cover prescriptions you take at home.
Medicare Part C is the Medicare Advantage program. This is a way to get your Medicare Part A and Part B benefits through a private, Medicare-approved company. Hospice benefits are the exception – you still get these benefits but they’re covered directly under Part A. Many Medicare Advantage plans include prescription drug coverage, and some plans include extra benefits, like routine dental services. You must still continue paying your monthly Part B premium and any premium the Medicare Advantage plan may charge.
Medicare Part D is Medicare’s prescription drug coverage program. As with the Part C program, Part D benefits are provided through private, Medicare-approved insurance companies. If you have Medicare Part A and/or Part B, you can sign up for a stand-alone Medicare Part D Prescription Drug Plan.
As you can see, your Medicare prescription drug benefits can come from either a Medicare Advantage Prescription Drug plan or a stand-alone Medicare Part D Prescription Drug Plan. It’s an optional benefit, but if you don’t sign up for Medicare prescription drug coverage when you’re first eligible for Medicare, and then you decide you want it later on – you could face a late-enrollment penalty.
Plan availability may vary depending on where you live. You can use the Find Plans button on this page to look for plans in your area.
What does Medicare prescription drug coverage cost?
The cost of your Medicare plan and the amount that you pay for medications such as DiaBeta, may be different from one plan to another, depending on several factors such as:
- The prescription medications that you use
- The plan you select
- Whether you use a pharmacy in your plan’s network, if applicable
- Whether your plan covers your prescription medications
- The plan’s out-of-pocket costs, such as a deductible, coinsurance, and out-of-pocket maximum
- Whether you currently receive Medicare Extra Help
Will my plan cover DiaBeta?
Every Medicare plan that includes prescription drug coverage maintains its own formulary – this is a list of covered drugs divided into “tiers” for pricing purposes. To find out whether a plan you’re considering covers DiaBeta or its generic form, glyburide, check the plan’s formulary. The formulary may change at any time. You will receive notice from your plan when necessary.
Find out more
If you want to explore your Medicare plan options, I am happy to help. Please feel free to call me or have me email you additional information by clicking the links below.
- Click on “Compare Plans” or “Find Plans” to start familiarizing yourself with some Medicare plan options near you.