There are some drugs covered under Medicare Part B, which is part of original Medicare. These types of drugs are usually drugs given to you by a doctor or health care professional in their office. Drugs that are not covered by Part B are usually covered under your Prescription Drug Plan (Part D). If you have Part D, check your plan’s formulary to see what drugs are covered.
Examples of drugs covered by Part B:
-Drugs used with an item of durable medical equipment: for example an infusion pump or nebulizer.
-Some antigens
-Injectable osteoporosis drugs
-Erythropoisis–stimulating agents
-Blood clotting factors
-Injectable and infused drugs
-Oral End-Stage Renal Disease (ESRD) drugs
-Parenteral and enteral nutrition (intravenous and tube feeding)
-Intravenous Immune Globulin (IVIG) provided in the home
-Shots (vaccinations)
-Flu shots
-Pneumococcal shots
-Hepatitis B shots
-Other shots: Medicare helps pay for some other vaccines when they’re directly related to the treatment of an injury or illness.
-Transplant drugs(also called immunosuppressive drugs)
-Oral cancer drugs
-Oral anti-nausea drugs
-Self-administered drugs in hospital outpatient settings
-For covered 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 assignments for Part B drugs, so you should never be asked to pay more than the coinsurance or copayment for the drug itself.
-For covered Part B prescription drugs you get in a hospital outpatient setting, you pay a copayment. If you get drugs not covered under Part B in a hospital outpatient setting, you pay 100% for the drugs, unless you have 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.
If you have questions or are confused about what you will be liable for, book a meeting with a licensed agent. The goal is to lower your potential cost as low as possible while still receiving great medical care when you need it and giving you peace of mind.
