Does Medicare Cover Lopressor?

Pamela Cannaday by Pamela Cannaday | Licensed since 2011
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This article was updated on: 09/10/2018

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Medicare Part A and Part B doesn’t cover Lopressor (metoprolol tartate) in most situations. According to the National Institutes of Health, Lopressor is sometimes used to treat conditions such as:

  • High blood pressure
  • Chest pain
  • Heart attack (to help with recovery)

You may be able to get coverage for Lopressor if you’re enrolled in a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan.

When might Medicare cover Lopressor?

Lopressor is generally prescribed to treat high blood pressure and angina, or chest pain, according to the National Institutes of Health (NIH). It’s in a class of medications known as beta blockers that work by relaxing the blood vessels, lowering your heart rate and your blood pressure. It also reduces the oxygen requirements of the heart, according to the Food and Drug Administration (FDA). Its generic name is metoprolol tartrate. Lopressor is often prescribed to help manage certain types of heart disease. Lopressor is also sometimes prescribed after a heart attack.

Under Original Medicare, there is generally no coverage for prescription medications such as Lopressor, except in certain limited situations, such as:

  • You are an inpatient in a hospital or nursing home during a covered stay.
  • You get Lopressor by injection or infusion in your doctor’s office or outpatient facility, such as an emergency room.

Lopressor taken by mouth at home is not generally covered, unless you have a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan that covers it.

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

Stand-alone Medicare Part D Prescription Drug Plans are available to anyone who is eligible for Medicare and enrolled in Part A and/or Part B. You can also get Part D coverage for prescription drugs in a Medicare Advantage Prescription Drug plan (MAPD). With a Medicare Advantage plan, you will have to continue to pay the Part B premium.

Before you enroll in a plan, you may want to check the formulary to be sure that Lopressor and any other medications you take on a daily basis are covered. A formulary is simply a list of covered medications. Plans may change their formularies from time to time, but they will notify you in writing of any changes before they take effect. You can use the Compare Plans tool on this page to search for plans in your area that may cover Lopressor – just enter your zip code to get started.

Enrolling in Medicare Part D coverage for prescription drugs such as Lopressor is entirely voluntary, but if you think you’ll want the coverage, you might want to enroll as soon as you are eligible. If you don’t, you may have to pay a late-enrollment penalty with your monthly premium for as long as you have Medicare prescription drug coverage, unless you’ve had continuous creditable prescription drug coverage through another source, such as an employer plan. You can enroll in Medicare Part D prescription drug coverage, or switch to a Medicare Advantage Prescription Drug Plan, during the Annual Election Period, or during other special enrollment periods if you meet certain requirements.

How do I choose the right Medicare Part D Prescription Drug Plan for Lopressor?

Deciding between a stand-alone Medicare Prescription Drug Plan to work alongside Original Medicare, and a Medicare Advantage Prescription Drug plan, is a personal decision; you need to compare benefits and out-of-pocket costs for each to see which works best for you. However, if you have a chronic condition such as heart disease or hypertension, you may prefer the benefits and convenience of a Medicare Advantage plan.

Medicare Advantage plans are an alternative way to get your Medicare Part A and Part B benefits. They must offer at least the same coverage as Original Medicare (except for hospice care, which is still covered by Part A), but many include prescription drug coverage and additional benefits to help you manage your condition. You may be able to enroll in a Medicare Advantage plan that may cover wellness programs and even offers discounted gym memberships and other health benefits. Some may even cover routine vision, dental, and hearing care.

If you’d like help understanding your options for Medicare coverage of prescription drugs such as Lopressor, 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 that you may qualify for, click the Compare Plans or Find Plans button.

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Pamela Cannaday |
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