Does Medicare cover Lomotil?

Victoria Burke by Victoria Burke | Licensed since 2011
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This article was updated on: 10/21/2018

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If you suffer from diarrhea, your doctor might prescribe Lomotil. According to the National Institutes of Health’s Medline Plus website, Lomotil is a prescription drug combining the anti-diarrheal medication diphenoxylate with atropine, a medication that can help reduce spasms in the stomach and intestines. Lomotil, in either tablet or liquid form, is generally not covered by Original Medicare (Part A and Part B). However, a Medicare plan that includes prescription drug coverage might cover Lomotil.

How can I get Medicare Part D prescription drug coverage for Lomotil?

Medicare Part D is the prescription drug coverage part of Medicare. This optional coverage is available through private, Medicare-approved insurance companies. You have a couple of different options for the type of Medicare prescription drug coverage you enroll in.

  • If you’re enrolled in Original Medicare (Part A and/or Part B), you can sign up for a stand-alone Medicare Part D Prescription Drug Plan coverage to complement your coverage.
  • If you prefer getting your Medicare Part A and Part B benefits through the Medicare Advantage program, you can enroll in a Medicare Advantage Prescription Drug plan. Medicare Advantage plans include all Part A and Part B benefits besides hospice care, which is still covered directly under Part A. Medicare Advantage plans often include prescription drug coverage, and sometimes other benefits too – such as routine dental or vision care. You still need to pay your Medicare Part B premium, along with any premium the Medicare Advantage plan may charge.

Although the Medicare Part D program is overseen by the federal government, the individual plans are administered by private insurance companies, so the plan benefits, premiums, deductibles, copayments, and coinsurance amounts may vary among plans.

Each plan that includes Medicare prescription drug coverage uses a formulary, or list of approved medications and the benefits available for each. If you take Lomotil and want help paying for your medication, be sure to check the formulary of any plan you are interested in to see if Lomotil is covered. Medicare requires all plans that include Medicare prescription drug benefits to cover common medications to treat a wide range of illnesses and conditions, but individual coverage decisions are up to each particular plan.

It’s important to note that plans may change their formularies occasionally, but you will receive notice from your plan when necessary. If Lomotil or another drug you take regularly is on your plan’s formulary right now, there is no guarantee that it will always be covered. You may want to review your plan’s Annual Notice of Change, which your plan will send you in the fall of each year. That notice will tell you about any coverage changes.

Participation in the Medicare Part D prescription drug program is entirely voluntary. However, if you think you want this coverage, you may want to enroll in a plan that includes this benefit as soon as you are eligible for Medicare. If you don’t do it right away, but later decide you want Medicare coverage for prescription drugs like Lomotil, you may have to pay a late-enrollment penalty with your monthly premium for as long as you have Medicare prescription drug coverage.

It may be a good idea to look at plan benefits, premiums, and out-of-pocket costs for any Medicare plan you’re considering, to see which one may work for you. You can use the Find Plans button on this page to search for plans in your area that cover Lomotil.

Would you like assistance finding Medicare coverage for Lomotil and other prescription medications? I’m available to help. 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 button. You can also find out more about me by clicking the “View profile” link.

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