Key takeaways
- Medicare Part D prescription drug plans typically cover Stelara, as it is a self-administered, take-home prescription drug. Medicare Advantage plans that include prescription drug coverage also typically cover Stelara in the same way.
- Even with Medicare coverage, individuals may have out-of-pocket expenses for Stelara, including premiums, deductibles, and copayments, which vary depending on the specific plan.
- In accordance with Part D plan rules, once a person’s out-of-pocket expenses reach $2,000 ($2,100 in 2026), they will pay nothing further toward eligible prescription drugs for the remainder of the calendar year.
Stelara is an injectable medication to treat:
- psoriasis
- psoriatic arthritis
- Crohn’s disease
- ulcerative colitis
Medicare Part D will typically cover Stelara.
Part D covers prescription drugs. Stelara falls under Part D instead of Part B because it is a medication that a person administers themselves.
Medicare Advantage (Part C) plans often include prescription drug coverage (Part D) as part of a bundled plan. These plans will also generally cover prescriptions such as Stelara.
Even though Medicare will cover Stelara, people will still have to pay some out-of-pocket costs.
Out-of-pocket costs include premiums, deductibles, and copayments. Monthly premiums will vary because Part D plans are provided by Medicare-approved private insurance companies.
Deductible costs will vary by plan as well. However, in 2025, they cannot exceed $590 (increasing to $615 in 2026). After a person reaches their deductible, they will pay 25% of their prescription drug costs.
When a person’s out-of-pocket costs reach $2,000, they will enter the catastrophic coverage phase. This means they will not pay anything for prescription drugs for the rest of the year. In 2026, this amount will increase to $2,100.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.