Many injections are covered by Medicare B.
Medicare is made up of two primary parts: Part A, which covers hospital in-patient costs, and Part B, which covers outpatient medical expenses. Medicare Part D is coverage for prescription medications, although some specific medications are covered by Part B, a caveat that causes a great deal of confusion among Medicare beneficiaries trying to understand their coverage.
Part D Overview
Medicare Part D is the prescription drug program that began in 2001. If you are 65 or if you are disabled and qualify for Medicare, you are eligible for Medicare Part D. Medicare Part D works like any insurance, with a monthly premium for the policy and co-pays when you use it. The policies are sold by private insurance companies in each state.
Part B Overview
Medicare Part B is sometimes referred to as "medical insurance" because it pays for medical services and supplies. This could include such things as doctor visits, preventive services, diagnostic tests, some therapies and durable medical equipment, such as wheelchairs. All outpatient services are covered by Part B, whether the setting is an emergency room, surgery center or pain clinic. A monthly premium is associated with Part B.
Enrolling in Part B and Part D
Enrollment for both Part B and Part D begins three months before the month of your 65th birthday and lasts until three months after. If you have other health insurance with drug coverage through your employer or a retiree plan, you may not need to enroll. You will need to ensure that the coverage you have is "creditable," meaning at least as good as Medicare coverage, to avoid paying a penalty if you decide to enroll later. Part D plans can be changed every year during the annual open enrollment period from November 15 through December 31.
Part D Covered Drugs
Medicare Part D covers prescription medications that are provided directly to patients by a pharmacy. The companies that sell Part D policies have formularies, or lists of the drugs they cover. The formularies are tiered, meaning that the more expensive drugs have higher co-pays than less expensive ones. The plans are regulated by the government and each plan must include drugs in the most commonly prescribed categories and classes. If you are prescribed a drug not on your plan's formulary, you can apply for an exception to get coverage until the next open enrollment period, when you can switch to a different plan.
Part B Covered Drugs
Medicare Part B does not cover prescription drugs are but does cover certain drugs that are used in an outpatient setting, like chemotherapy drugs. In general, any injectable drug administered by a trained medical professional would be covered under Medicare Part B, including vaccines. Some self-administered drugs are also covered, including drugs used in conjunction with home dialysis, oral cancer drugs, and injectable osteoporosis drugs. While insulin is covered by Part D, test strips, glucose monitors and lancets are covered by Part B.
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