Medicare provides many healthcare benefits, but it is common for recipients to have questions regarding coverage for medications. Finding affordable ways to pay for medications you need to improve or maintain your health is a concern for millions of Medicare recipients. If your physician prescribes Ultram, you will need to understand what options are available to help cover the costs of these prescription drugs.
What Is Ultram?
Ultram is the brand name for a generic drug called Tramadol. This opiate-based analgesic is typically prescribed for people who need relief from moderate to severe pain. Since Ultram is a controlled substance with the potential to be habit-forming, it is not available over-the-counter. Instead, a physician must prescribe the medication, and this can affect coverage by a Medicare prescription drug plan.
Which Medicare Plans Cover Ultram?
When you sign up for Medicare, you are given an option to get your benefits through Original Medicare, the federal program that administers your coverage, or through a Medicare Advantage plan offered by private insurance companies that contract with Medicare to provide your Part A and Part B benefits.
Medicare Part A may include coverage of medications administered to you during your stay as an inpatient in a Medicare-approved hospital or hospice facility. Medicare Part B covers some pain medications if they are administered by a medical provider in an outpatient care facility. Unfortunately, Medicare Part A and Part B do not include any coverage for prescription medications you would have filled at a pharmacy to take at home.
Medicare Part D prescription drug coverage can help you pay for medications, such as Ultram, that are prescribed by your doctor due to a medical need. If you have Original Medicare, you may enroll in a stand-alone Prescription Drug Plan (PDP). If you choose to get your Medicare benefits through a Medicare Advantage plan, you should know that MA plans are required to offer the same Part A and Part B benefits as Original Medicare, but many offer additional coverage, such as prescription drug benefits.
Medicare Advantage plans with prescription drug coverage (MA-PDs) and PDPs each have their own formularies, or lists of covered drugs. The formulary and the cost of medications can vary from plan to plan. As you check the formulary, remember that it can be common for insurance companies to only cover the generic form of the drug, so be sure to look for the name Tramadol among the covered medications.
How Does Medicare Part D Work for Covering Ultram?
Many Medicare recipients rely on a Part D plan to help pay for their medications. While a Prescription Drug Plan is an asset, some policies have a brief period where you need to pay full price for the medication until you hit an annual deductible amount. Once you hit the deductible, you may only have to pay a copayment or coinsurance for your prescriptions.
Getting your medications covered can be essential, especially when you rely on Ultram or another medication to treat an illness or injury or manage your health. Ultram may be covered by Medicare Part D benefits. Check with your plan directly to make sure it is included in the formulary and to determine your exact costs. If your medication needs have changed over the past year and your current prescription drug plan no longer meets your needs, you may be able to switch plans during Medicare’s Annual Election Period, from October 15 through December 7.