Does Medicare Cover Potassium Chloride?
- Potassium chloride is commonly prescribed to treat or prevent low potassium levels. This article explains which Medicare policies cover potassium chloride.
Purchasing supplemental prescription drug coverage can help you manage the costs of prescription medications, such as potassium chloride. Below, find out which Medicare plans cover potassium chloride and how cost-sharing works.
What Is Potassium Chloride?
Potassium is essential for keeping your heart, nerves and other body systems healthy. Your health care provider may recommend that you take potassium chloride if you have low potassium levels or have a higher risk of developing a potassium deficiency.
Potassium chloride is available in several forms, including capsules and oral liquids. Your doctor may prescribe generic potassium chloride or one of the following branded medications:
- K-Tab
- Klor-Con
- Klor-Con Sprinkle
The correct potassium chloride dosage depends on several factors, including the severity of your potassium deficiency, your age and your general health. Doctors often recommend taking potassium chloride with food and avoiding lying down for around 30 minutes after taking your medication to reduce the risk of stomach irritation.
Potassium Chloride Side Effects
Other side effects may include:
- Nausea
- Vomiting
- Diarrhea
- Bloating
- Stomach ulcers
Does Medicare Cover Potassium Chloride?
Your Medicare plan won't cover potassium chloride if you only have Original Medicare (Parts A and B) because it doesn't cover self-administered drugs. However, all Medicare prescription drug plans cover potassium chloride.
Which Medicare Plans Cover Potassium Chloride?
Two Medicare plans typically cover potassium chloride and other prescription medications: Medicare Part D and Medicare Advantage. Medicare Part D supplements your existing Original Medicare coverage to add prescription drug coverage. You can purchase a Part D plan from a private health insurer.
Medicare Advantage plans are also available through Medicare-approved private companies. Unlike Part D, they replace Original Medicare coverage and must provide identical essential benefits.
However, many Medicare Advantage policies come with enhanced benefits, often including prescription drug coverage. If your Medicare Advantage policy includes this benefit, you'll likely have coverage for potassium chloride. You can find out whether you have potassium chloride coverage by consulting your policy's formulary, typically under Tier 4.
How Much Does Potassium Chloride Cost With Medicare?
Potassium chloride costs around $417 or less for a 473-milliliter bottle of 10% oral solution. However, retail prices depend on various factors, including where you live and which pharmacy you use. You can sometimes find online coupons to reduce the cost of potassium chloride and other prescription medications.
You'll pay the full retail price for your medication until you spend enough to meet your plan's annual deductible. Insurers can charge up to the maximum Part D deductible of $545 (rising from $505 in 2023). Medicare Advantage deductibles are more variable and can range from $0 to several thousand dollars.
Once your insurer starts paying for your medications, you may need to contribute a co-pay. Co-pays for potassium chloride rarely exceed $1. Sometimes, insurance companies waive co-pays altogether.
Medicare Coverage Restrictions for Potassium Chloride
Whether your policy restricts coverage for potassium chloride depends on your insurer. However, most companies don't ask for prior authorization from your health care provider or set quantity limits.
