Medicare prescription drug coverage can be complicated and difficult to understand. We recognize how frustrating this can be and would like to share some information to help our patients better understand Medicare prescription drug coverage.
Self-administered drugs (or drugs you would normally take on your own) provided in an outpatient setting are at the root of much of this frustration. These drugs may or may not be covered based upon which Medicare coverage you have. According to the Centers for Medicare & Medicaid Services, Medicare Part B generally covers care you get in a hospital outpatient setting, such as an emergency department, observation unit, surgery center, or pain clinic. Some prescription drugs, including drugs given through an IV (intravenous infusion) may also be covered by Part B. Generally, Part B does not pay for self-administered drugs unless they are required for the hospital outpatient services you’re receiving.
If you receive self-administered drugs that aren’t covered by Medicare Part B, the hospital may bill you for the drug. Patients who are enrolled in a Medicare drug plan (Part D) may have additional coverage that may cover drugs not covered by Part B.
We have provided an easy-to-read document from Centers for Medicare & Medicaid Services that provides detailed, in-depth information regarding the coverage of self-administered drugs. To learn more, click here.
For detailed, in-depth information about all Medicare Drug Coverage, please click here.
If you have additional questions or concerns regarding your coverage, you can contact Medicare directly by doing the following:
■■Look for more information on appeals at Medicare.gov/appeals.
■■Look for more information on Medicare drug coverage in the “Drug Coverage (Part D)” section. Select “Find health & drug plans.”
–Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
–Contact the Maine State Health Insurance Assistance Program (SHIP) to get free personalized health insurance counseling.
■■Call:1-800-262-2232 or Visit:http://www.maine.gov/dhhs/oads/community-support/ship.html