Does Medicare Cover Vytorin?

Pamela Cannaday by Pamela Cannaday | Licensed since 2011
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This article was updated on: 09/12/2018

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Vytorin is a combination medication people may take to lower cholesterol levels, according to the United States Food and Drug Administration. In order for you to receive Medicare coverage for Vytorin or the generic combination of simvastatin and ezetimibe, you generally must have a Medicare-approved prescription drug plan that offers coverage for Vytorin.

What are the parts of Medicare coverage?

Medicare offers government-provided insurance to people over 65 and other eligible beneficiaries. There are four parts of Medicare, and you must have the right coverage in order to have Medicare cover Vytorin. Medicare Part A provides hospital insurance, as well as nursing home care, hospice care, home health services, and other types of care.

Medicare Part B covers clinic care, doctor visits and other forms of preventive health care.  Medicare Part A and Part B are sometimes called “Original Medicare” and do not usually cover prescription drugs such as simvastatin and ezetimibe unless you receive it as part of inpatient hospital stay. Medicare Part C is insurance coverage through a Medicare-approved private insurance company. Medicare Part D offers prescription drug coverage, which may include Vytorin.

When does Medicare cover Vytorin through Medicare Part D?

You may get prescription drug coverage by opting for a stand-alone Medicare Part D Prescription Drug Plan, or a Medicare Advantage plan that also offers coverage for prescription drugs. You may enroll in Part D after you turn 65, or under 65 if you have a disability, if you have Medicare Part A or Medicare Part B. You may have to pay a late-enrollment penalty if you do not enroll in a Medicare Prescription Drug Plan (Part D) coverage during your initial enrollment period.

Medicare Advantage plans function as an alternative way to get your Original Medicare benefits and often provide similar levels of coverage, except hospice care, which Part A still covers. Medicare Advantage plans may also offer additional benefits, and you may be able to get a Medicare Advantage plan in your area that covers prescription drugs without requiring you to enroll in a stand-alone Part D Prescription Drug Plan. The plan formulary will identify if it covers Vytorin, and the formulary could change at any time. You will receive notice from your plan of coverage if there are any changes to the formulary.

How do I get Medicare coverage for Vytorin?

Doctors prescribe the combination of simvastatin and ezetimibe, known as Vytorin, to treat certain types of high cholesterol in patients.

  • If your Medicare Advantage Prescription Drug plan has a preferred network, make sure that the prescribing doctor and pharmacy are within the network.
  • If you have Medicare Part B and a stand-alone Medicare Part D Prescription Drug Plan, confirm that the doctor accepts Medicare.
  • Check your Medicare Advantage Prescription Drug plan or Medicare Part D Prescription Drug Plan to see if Vytorin is included in the plan formulary. Coverage for certain medications is not guaranteed by Medicare.

Should you want to know more about Medicare coverage for Vytorin, I am ready to provide more information.

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