Medicare Part B (Medical Insurance) generally doesn’t cover most prescription drugs used at home, but it does cover a limited number of outpatient prescription drugs under limited conditions.
Generally speaking, prescription drugs covered under Medicare Part B usually wouldn’t be drugs that you would self administer, like those you get at a doctor’s office or hospital outpatient setting.
Drugs not covered under Medicare Part B may be covered under a Medicare Prescription Drug Plan (Medicare Part D). If you have Medicare Part D, check your plan’s formulary to see what prescription drugs are covered. You want to make sure essential prescription drugs you currently are taking are covered by the Medicare Part D plan you choose.
Examples of Drugs Covered by Medicare Part B:
Drugs infused through an item of durable medical equipment, like an infusion pump or drugs given by a nebulizer.
Some antigens: if they’re prepared by a doctor and given by a properly instructed person (who could be the patient) under appropriate supervision.
Injectable osteoporosis drugs for women with osteoporosis who meet the criteria for the Medicare home health benefit and have a bone fracture that a doctor certifies was related to post-menopausal osteoporosis. A doctor must certify that the woman is unable to learn how or unable to give herself the injection. The home health nurse or aide won’t be covered to provide the injection unless family and/or caregivers are unable or unwilling to perform the procedure.
Erythropoisis–stimulating agents: erythropoietin by injection if you have End-Stage Renal Disease (ESRD) or need this drug to treat anemia related to certain other conditions.
Blood clotting factors such as hemophilia: Medicare helps pay for clotting factors you give yourself by injection.
Medicare covers most injectable and infused drugs given by a licensed medical provider.
Medicare helps pay for some Oral End-Stage Renal Disease (ESRD) drugs if the same drug is available in injectable form and covered under the Part B ESRD benefit.
Parenteral and enteral nutrition (intravenous and tube feeding): Medicare helps pay for certain nutrients for people who can’t absorb nutrition through their intestinal tracts or can’t take food by mouth.
Medicare helps pay for: Intravenous Immune Globulin (IVIG) provided in the home: for people with a diagnosis of primary immune deficiency disease. A doctor must decide that it’s medically appropriate for this treatment to be given in the patient’s home. Part B covers the IVIG itself, but Part B doesn’t pay for other items and services related to the patient getting the IVIG in his or her home.
Medicare helps pay for Shots & Vaccinations such as: Flu shots, Pneumococcal shots & Hepatitis B shots as well as other vaccines when they’re directly related to the treatment of an injury or illness.
Transplant drugs or immunosuppressive drugs: Medicare covers transplant drug therapy if Medicare helped pay for the organ transplant. (Part D may cover other transplant drugs not covered by Part B, even if Medicare didn’t pay for the transplant. If you’re entitled to Medicare only because of permanent kidney failure, your Medicare coverage will end 36 months after the month of the transplant. Medicare won’t pay for any services or items, including transplant drugs, for patients who aren’t entitled to Medicare.
Medicare will continue to pay for your transplant drugs with no time limit if you meet either of these conditions:
- You were already entitled to Medicare because of age or disability before you got ESRD.
- You became entitled to Medicare because of age or disability after getting a transplant that was paid for by Medicare, or paid for by private insurance that paid primary to your Medicare Part A (Hospital Insurance) coverage, in a Medicare-certified facility.
Transplant drugs can be very costly. If you’re worried about paying for them after your Medicare coverage ends, talk to your doctor, nurse, or social worker. There may be other ways to help you pay for these drugs.
Medicare helps pay for some oral cancer drugs you take by mouth if the same drug is available in injectable form or is a prodrug of the injectable drug.
A prodrug is an oral form of a drug that when ingested, breaks down into the same active ingredient found in the injectable form of the drug.
Medicare helps pay for oral anti-nausea drugs used as part of an anti-cancer chemotherapeutic regimen. The drugs must be administered immediately before, at, or within 48 hours after chemotherapy, and must be used as a therapeutic replacement for intravenous anti-nausea drugs.
Medicare may pay for some self-administered drugs, like drugs given through an IV, if you need them for the hospital outpatient services you’re getting.
Your Costs in Original Medicare
For covered Medicare Part B prescription drugs you get in a doctor’s office or pharmacy, you pay 20% of the Medicare-approved amount, and the Part B deductible applies. They must accept assignment for Medicare Part B drugs, so you should never be asked to pay more than the coinsurance or co-payment for the drug itself.
To avoid the 20% portion, you’ll need a medicare supplement plan. To figure out which is the best and most affordable medicare supplement plan, it is highly advised to meet and discuss your needs with an independent medicare supplement agent.
For covered Medicare Part B prescription drugs you get in a hospital outpatient setting, you would pay a co-payment. If you get drugs not covered under Medicare Part B in a hospital outpatient setting, you pay 100% for the drugs, unless you have Medicare Part D or other prescription drug coverage; what you pay depends on whether your drug plan covers the drug, and whether the hospital is in your drug plan’s network.
These are all issues that an experience and qualified Medicare Supplement Agent can help you with.
For more information on how Florida Medicare Supplement Insurance can help with your health insurance needs call Neil Primack (561) 935-3907 or email him at: email@example.com.