Medicare Part B is one part of what’s known as Original Medicare. It covers outpatient medical services such as durable medical equipment, ambulance rides, ER stays, diagnostic tests, and other outpatient procedures. Although Original Medicare isn’t a reliable option for prescription drug coverage, it offers a limited form of prescription drug coverage under certain circumstances.
Prescription Drugs Covered Under Part B
Medicare Part B covers drugs that are used with approved durable medical equipment. For example:
- Part B covers drugs infused through an infusion pump or nebulizer.
- Part B covers certain antigens if they are prescribed and prepared by your doctor.
- If you are a woman with osteoporosis and you qualify for home health benefits under Medicare, Part B may cover injectable drugs if you have a bone fracture that is related to the condition.
- Part B enrollees with end-stage renal disease will receive coverage for erythropoiesis-stimulating agents.
- Part B covers blood clotting factors administered by yourself if you have been diagnosed with hemophilia.
- Part B also covers calcimimetic drugs under the ESRD payment system.
Medicare enrollees who have been diagnosed with primary immune deficiency disease will receive coverage for Intravenous Immune Globulin if a doctor certifies it as appropriate to be used at home. However, Part B does not cover other items or services related to using the drug at home. Part B also covers vaccinations such as flu shots, pneumococcal shots, Hepatitis B shots, and other vaccines, such as those used to treat an illness.
Enrollees who have had an organ transplant will receive coverage for transplant or immunosuppressive drugs if the transplant was paid for by Medicare. Medicare enrollees who qualify for Medicare on the basis of having end-stage renal disease will receive Medicare coverage until 36 months after a kidney transplant. However, enrollees who qualify for Medicare for other reasons have no time limit for receiving coverage for transplant drugs if Medicare paid for the procedure.
Lastly, Medicare Part B may cover certain self-administered drugs if you need them for approved outpatient hospital services. If you receive prescription drug coverage under Part B, you’ll typically pay for 20% of the costs as a copayment. The deductible for Part B also applies. However, there is no cost-sharing for flu shots, Hepatitis B shots, and pneumococcal shots.
Other Medicare Options
If you receive drugs outside an outpatient setting, you will cover all the costs unless you have prescription drug coverage through Medicare Advantage or limited coverage through Medicare Part B. Do keep in mind that Medicare Part D offers more coverage for prescription medications than Original Medicare. If you are interested in having more comprehensive prescription drug coverage than the limited coverage Part B provides, enrolling in a Part D plan is worth considering.
Need Coverage? We Can Help!
For more information about prescription drug coverage through Medicare, contact Jersey Medicare Solutions today!
Thomas M. Brzezinski is one of the founding partners of WMAG William & Michael Advisor Group LLC and Jersey Insurance Solutions. He has been involved in the insurance industry for over ten years and specializes in developing client relationships that last a lifetime.
