Cholesterol is a naturally occurring substance in the body. It helps digestion and keeps cells healthy. Unfortunately, this wax-like substance can also cause cardiovascular problems when large amounts are present. Too much cholesterol can lead to plaque that builds up on the walls of arteries and potentially leads to blockages in blood flow. Ultimately, this can cause a heart attack, or in cases where plaque breaks and causes internal bleeding, clots can develop that lead to a stroke.
Although diet and exercise are often the best methods for controlling cholesterol, some people need additional help through prescription medications like Zocor (simvistatin). As a statin medication, Zocor reduces the amount of cholesterol produced in the body, and when taken as prescribed, it can possibly lower the risk of heart attack and stroke for patients who are facing elevated levels of cholesterol.
Does Medicare Cover Zocor?
Medicare Part D offers prescription drug coverage for a number of medications, and thankfully, Zocor is one of them. Whether you have Part D benefits through a stand-alone plan with Original Medicare or through a Medicare Advantage plan, Zocor should be listed as a covered item under your plan’s formulary. This is the list of covered drugs issued by your plan provider. It is governed by Medicare, but your plan may have exceptions. If your plan does not cover Zocor, you can work with your primary care physician and your plan manager to either find a suitable alternative that is covered or file for an exemption.
Zocor and Hospital Coverage Under Medicare
If you receive treatment with Zocor while in a hospital or skilled nursing facility, this will typically be covered under Medicare Part A. While the medication itself may be covered, you may encounter separate billing from any specialists who administer the drug. If these medical professionals are not Medicare-approved providers, Medicare may not cover the cost of their services.
Zocor and Treatment in a Doctor’s Office
You may also receive Zocor while in a physician’s office. This may be the case if you are taking the medication and being monitored to measure the drug’s efficacy in the treatment of your health concerns. If Zocor is administered in such a setting, it may be eligible for a claim under Medicare Part B as this is the outpatient benefit for Medicare. There may be a co-payment involved in this situation, so it’s important to understand your coverage first by speaking with your Medicare coverage plan manager for more details.
Medicare Advantage and Wellness
As stated, controlling cholesterol is often possible through diet and exercise, and if you’re a Medicare Advantage plan member, you may be able to receive certain wellness benefits that are not provided through Original Medicare. These may include things like access to fitness classes and gyms in your area. Talk to your doctor about lifestyle changes that may help lower your cholesterol and find out how your Medicare coverage can help.