Most prescription drugs are covered by Medicare Part D, but SOME are Part B drugs. What’s the difference? Where is the list of Part B drugs? GA Medicare Plans. Do Advantage Plans include Part B coverage for insulin?
When you have original Medicare and a supplement plan (Medigap) your drugs are covered under a separate Part D plan. Even if you have an Advantage plan (MAPD) drugs are also Part D baked into your plan.
What is a Part B?
Medicare Part B is normally limited to outpatient HEALTH CARE. Part B will cover doctor visits, labs, X-rays, MRI, CAT scan, ER (Emergency Room), Ambulance (when it is a medical necessity), physical and occupational therapy and so forth.
Part B also covers certain medications and durable medical equipment like diabetic test strips, nebulizers, and wheelchairs.
Part D pays for drugs you take regularly for chronic conditions such as: heart disease, high cholesterol, or asthma. It also covers medications you take for a short period of time, such as antibiotics.
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But why are SOME Drugs Covered by Medicare Part B, yet Others are not?
For certain medical conditions some of your medications are covered by Part B. For example, Medicare covers flu vaccination once every fall-winter season under its Part B benefit. Also, insulin may be covered if you have a CGM pump, but it falls under Part D if you self inject.
Medication for a nebulizer is another example of a drug that may be covered by Part B.
Most pharmacies cannot bill Part B Medicare prescriptions referred to as Part B drugs) or medical equipment.
If you need Part B drugs or medical equipment, ask if your pharmacy is able to bill your medical plan directly.
Specialty DME (durable medical equipment) providers that may be approved by Medicare include:
Wheel chairs and walkers
Hospital beds and transfer devices
Infusion pumps
Oxygen
Compound and specialty pharmacy
Mail order pharmacy
Does Part B Cover Vaccines?
There are two vaccines for pneumonia that protect against different types of the infection.
Medicare B (Medical Insurance) covers 2 different pneumococcal shots. Part B covers the first shot at any time and a different, second shot if it’s given at least one year after the first shot.
PCV13 helps protect people from 13 of the most severe types of bacteria that cause pneumonia.
PPSV23 protects against an additional 23 types of pneumonia bacteria. Neither can prevent every type of pneumonia, but they work against more than 30 common, severe types.
People who need a pneumonia vaccine should get both shots: first, the PCV13 shot and then the PPSV23 shot a year or more later.
For most people, one of each shot should be enough to protect them for their entire lives.
Does Medicare Pay for Shingles Vaccine?
Shingles vaccine, including the new Shingrix formula, is included in your Medicare Part D benefit.
Shingles, or herpes zoster, is a skin rash that is caused by the same virus that causes chickenpox. Symptoms include blisters, burning, itching, fever, and pain. It usually takes about two to three weeks to clear up.
According to Mayo Clinic:
The signs and symptoms of shingles usually affect only a small section of one side of your body. These signs and symptoms may include:
- Pain, burning, numbness or tingling
- Sensitivity to touch
- A red rash that begins a few days after the pain
- Fluid-filled blisters that break open and crust over
- Itching
How Do Most Vaccines Work?
Most vaccines start with some form of the virus which is injected. The idea is your body will detect the intruder and generate anti-bodies to attack the virus.
Older vaccines such as Zostavax use a weakened form of the virus. Shingrix, approved in 2017, uses inactivated (dead) virus. Vaccines containing dead virus cells eliminates the risk of transmission.
Is Insulin Covered by Medicare B or Part D?
If you have an insulin pump your insulin and other diabetic supplies may also qualify for Part B coverage.
Many retail pharmacies cannot bill a medical plan for Medicare medical prescriptions (commonly referred to as Part B drugs) or medical equipment.
WALGREENS has a specialty pharmacy that can help with your intravenous medications (including insulin) and other specialty medications
https://www.walgreens.com/topic/pharmacy/specialty-pharmacy.jsp
Many Part B Drugs are Administered in a Clinical Setting
Part B drugs are often administered by a health care provider (i.e. vaccines, injections, infusions, nebulizers, etc.), or through medical equipment at home.
Some pharmacy’s administer vaccines without a prescription. Shingrix and flu vaccines do not require a doctor’s order and may be free at your local pharmacy.
What are examples of drugs covered under Part B?
Examples include:
Injections for osteoporosis
Some transplant medications
Immunosuppressants
End-stage renal disease (ESRD) medications
Flu, pneumonia, and Hepatitis B shots
Medicare Part D may cover medications that aren’t covered under Part B, and vice versa.
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