Does Medicare Cover Augmentin?
- Does Medicare Cover Augmentin?
When you get certain types of bacterial infections, your doctor may recommend that you take the drug Augmentin to help clear it up. This medication is only available with a prescription, which means that your insurance coverage determines the cost.
If you have any type of medication coverage through Medicare, you don't have to worry — all Medicare prescription drug plans cover Augmentin. It's important to understand how your costs might vary based on the stage of coverage and your other prescription needs.
What is Augmentin Used For?
Augmentin is one of the brand-name versions of amoxicillin and clavulanate. It's a prescription drug used to treat bacterial infections in many parts of the body. Your doctor might prescribe it for a wide range of conditions, such as bacterial pneumonia, sinus infections and urinary tract infections.
Augmentin isn't used to treat viral infections, such as influenza, viral pneumonia, colds or chicken pox.
When amoxicillin and clavulanate are combined, they create a powerful antibiotic. Amoxicillin is part of the penicillin antibiotic family. It works by killing existing bacteria and preventing additional bacteria from growing.
Clavulanate is a beta-lactamase inhibitor; it helps amoxicillin fight off types of bacteria that create beta-lactamase. That's why Augmentin is often used to treat lower respiratory infections — the two medications are more potent as a combination than they are alone.
Typically, Augmentin is taken by mouth as a tablet. Your doctor provides instructions for the dosage; they'll also tell you how long you should take the medicine. Since Augmentin is an antibiotic, it's important to take it according to the doctor's recommendations. Unnecessary antibiotics can pave the way for drug-resistant infections down the line.
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How Much Does Augmentin Cost if You Have Medicare?
Although all Medicare Part D prescription drug plans and some Medicare Advantage plans cover Augmentin, your costs depend on a number of factors. The most important one is your deductible. When you get an Augmentin prescription early in the year, or if you don't typically take prescription drugs, you might not have met your plan's deductible. The exact amount varies by plan but can't be higher than $545 in 2024 and $505 in 2023. Until you meet your deductible, expect to pay full price for the medication. Costs can vary considerably between cities and pharmacies, so it's a good idea to check costs in a variety of locations.
Once you purchase enough prescription drugs to meet your deductible, you'll only be responsible for a co-pay or coinsurance payment. This amount is different from plan to plan; it could be a flat fee, or you might be responsible for a percentage of the drug costs.
Many plans place Augmentin in Tier 2, which means the co-pay is usually affordable. You can find details in your plan's formulary — the tiered list of covered medications.
Are There Any Restrictions on Augmentin Coverage?
Your Medicare plan may restrict the amount of Augmentin you can receive at one time. However, you probably don't need to worry about it; your doctor will likely prescribe only as many tablets as you need to clear up the infection. Some plans may require your doctor to get authorization from the provider before prescribing this drug.
