S1E60 Part B Drug Benefits Explained

Medicare Parts B and D can pay for medications, but how they pay and what they pay for are different. Avoid billing surprises by learning what medications Part B will cover.

What medications are covered under Part B: https://www.medicare.gov/coverage/prescription-drugs-outpatient

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Transcript

Have you ever had to take your medication AT the doctor's office? It might be covered under a different part of your plan than you think! Find out all  about Part B covered medications this week on 65 and Counting!!

Welcome back, everyone! Sometimes, I’ll take a phone call from a person in crisis! For example, they’ll find themselves at the pharmacy trying to fill a prescription for medication only to hear that it’s not covered by their plan and it’s going to cost them a whole LOT of money! Well, often, there’s a simple solution and explanation and it’s not that the person is going to be stuck with the whole bill! Sometimes, certain medications and treatments are covered under Medicare’s Part B and not Part D. These are almost always outpatient medications that are still administered by a healthcare professional!

Medicare Part B covers a limited number of outpatient prescription drugs! Typically this coverage is on drugs you wouldn’t usually give to yourself like the kinds you get in a doctor's office or outpatient hospital setting! It’ll also cover some things that you use at home like medications for your nebulizer and diabetic supplies. 

Now, how do Parts A, B, and D work together to make sure all the meds you take in and out of the hospital are covered? Medicare Parts B and D can pay for the medications you receive in an ambulatory otherwise known as an outpatient setting but they won’t pay towards the same prescription. You can only use one part or the other. When you’re IN the hospital and admitted, the medications you receive will be covered under your Part A. Now, remember, if you’re in the emergency room and they send you home or just want to “observe” you, even if you stay overnight, the drugs will be covered under B or D because you weren’t admitted. 

If this happens, Part B will still pay for most drugs you receive in an IV form; however, if you receive oral medications, not on the approved list of Part B meds, you’ll receive a bill for those! But don’t worry! You can send copies of your bills for those other medications to your Part D provider and they’ll take care of reimbursement as long as the medication is in your plan's formulary! And if you’re on medicare advantage, the odds are you won’t have to worry about who’s paying for what, you just simply give the hospital your card and they’ll work out the billing for you!

What kinds of medications are covered under Part B? Well, it’s a long long list so we’ll just touch on this quickly and I’ll include a link in the description of the episode with a little more detail! 

https://www.medicare.gov/coverage/prescription-drugs-outpatient

Some medications covered by Part B include the drugs you put in your durable medical equipment like infusion pumps or nebulizers. Some antigens are also included if they’re prepped by a doctor and given to you by a properly trained person which could even be you under appropriate supervision. Injectable osteoporosis drugs, blood clotting factors, End-Stage Renal Disease Drugs, IV and Tube feeding medications. Pretty much anything the doctor has to give you or watch you give yourself is going to fall under this category. This includes a number of different vaccinations as well!

So, if it seems as though your Prescription Drug Plan or your Medicare Advantage Plans prescription drug portion won't cover one of your medications and it looks like you may have to pay it on your own, don’t worry! There are Certified Medicare Planners standing by waiting to take your call and help you determine if that medication is actually just covered on your Part B and not your Part D!

I hope you learned a whole lot about the medications you receive directly from the professionals, and how they’re covered! Don’t forget to like the video, subscribe to our page so you get notified when new episodes come out, and share with all your friends! But as always, most importantly, have a great week!