A majority of the Medicare beneficiaries rely upon Medicare Part D plan to have access to prescription drug coverage. However, people having some medical conditions may not even be aware that their Medicare Part B plan also covers some of their medications. Thus, people need to know that many of the adult vaccinations are covered under their Medicare Part B plan. With the price of medications increasing every year, there is a great need to cut the costs for people who require these drugs.
Medicare Part B Prescription Coverage
Individuals whether have opted for Original Medicare plan or for a Medicare Advantage plan, they have access to certain medications that are covered under Medicare Part B plan. Most of these drugs are limited to people having specific medical conditions. Find below the list of drugs covered under each Part B category:
- Chemotherapy drugs
- Medications for end-stage renal disease
- Anti-nausea medication, which is a part of a chemotherapy regimen
- Immunosuppressive medications for people who have had an organ transplant that was covered by Medicare
- Osteoporosis drugs for women who suffered a fracture due to post-menopausal osteoporosis
- Erythropoiesis-stimulating agents for people having ESRD or anemia
- Intravenous Immune Globulin (IVIG) for people with a diagnosis of primary immune deficiency disease
- Other injectable and infused medications
- Parenteral (IV) nutrition or tube feeds for people who are unable to take food by mouth
- Influenza vaccine
- Pneumococcal vaccine
- Hepatitis B vaccine for people who are at moderate to high risk
Medical Equipment that is Used for Administering Medications
- Nebulizer machines
- Infusion pumps
People must know that anti-nausea agents and oral chemotherapy require to meet certain criteria to be covered under Part B. The plan coverage requirements change on a yearly basis.
Part D Prescription Coverage
Medicare Part D plan covers the majority of the prescription medications, as these plans are required to cover at least two drugs in every therapeutic drug class. The six of the therapeutic drug classes include antipsychotics, immunosuppressants, antidepressants, chemotherapy agents, HIV/AIDS drugs, and seizure medications. Individuals also need to know that their Part D plans cannot charge more than 25% of the retail cost of those drugs. Individuals who are looking for a more extensive plan or a plan that covers some specific medications, then they need to carry out some research to find such a plan. The basic premium for a Part D plan in 2020 is $32.74 per month. In simple words, it can be said that the Medicare Part D plan covers what Part B doesn’t cover. If a person has gone through an organ transplant that was not covered by Medicare, then the immunosuppressant drugs will be covered by Part D and not Part B. Similarly if a person seeks Hepatitis B vaccine but was considered low risk, then that person has to turn to Part D to get coverage for the vaccine.
How Parts B and D Work Together
Both Medicare Part B and Part D plans pay for the drugs which the insured receives in the ambulatory setting but they will not pay for the same drugs. Individuals can only avail either Part B or Part D. However, individuals can use both the plans for drugs that they receive in a hospital setting.
Medications that the people receive while being admitted to the hospital as an inpatient is covered under their Part A deductible. People need to understand that when they are admitted to the emergency room and sent home or if they are under observation, and if they stay overnight in the hospital, then they can turn to Part B and Part D for their drug coverage.
When individuals are under observation, then Medicare Part B pays for the medications reviewed above and if they receive IV medications, then these will be covered. However, if individuals receive oral medications during their observation stay, which is not included on the Part B list of approved medications, then the individuals will be billed for each drug administered by the hospital. Individuals have to send copies of their hospital bills to their Part D plan for reimbursement. Unluckily, if an individual receives a medication that is on his/her Part D formulary, then their plan may not pay for it.