Medicare
How Does Medicare Cover Prescription Medication? Who can I contact if I need more assistance? covers drugs you need during a Medicare-covered stay in Part A
If payment is denied, you have a right to appeal the denial. Several drugs may be covered by Part B or Part D Some drugs may be covered under Part B or Part D, depending on what they are used for and how or where they are administered. These drugs include: Injectable drugs Part B covers injectable drugs if you usually cannot administer the drug yourself and your doctor provides the drug and administers it to you. Part D generally covers injectable drugs that you buy at the pharmacy, whether you or a doctor administers the drug. Vaccines Part B covers certain vaccines— flu shots, pneumonia shots, and hepatitis B shots for people who are at high risk of contracting hepatitis B. Part B also covers vaccines after you have been exposed to a dangerous virus or disease, such as tetanus. Part D covers most vaccines that your doctor recommends you get. Insulin Part B may cover insulin that you use with an insulin pump. Part D covers insulin and related medical supplies used to inject insulin (syringes, gauze, and alcohol swabs) if you self-inject insulin. Immunosuppressants Part B covers immunosuppressants if you received your transplant in a Medicare- approved facility and you had Part A at the time of your transplant. Part D covers immunosuppressants if you did not have your transplant in a Medicare-approved facility or you didn’t have Part A at the time of your transplant.
a hospital or a skilled nursing facility or drugs that you take for pain or symptom management while you are being covered by Medicare’s hospice benefit.
Call your State Health Insurance Assistance Program (SHIP) if you need help under- standing Medicare’s coverage rules, ap- pealing a denial, or applying for the Part D Limited Income Subsidy and/or a Medi- care Savings Program. Call your Senior Medicare Patrol (SMP) if you believe you were a victim of Medicare fraud or abuse. Your SMP can help you identify and report cases of fraud or at- tempted fraud. Pima Council on Aging is your SHIP and your SMP in Pima County. SHIP/SMP helpline: 520.790.7262 SHIP/SMP email: medicare@pcoa.org SHIP/SMP website: www.pcoa.org/ways- we-help/medicare To find a SHIP outside Pima County: Call 877.839.2675 or visit www.shiptacenter.org.
covers most drugs administered by your physician or someone
Part B
under the supervision of your physician or at a dialysis facility, but the provider or the facility must buy and supply the drugs. Part B also covers some outpatient prescription drugs, mainly certain oral cancer drugs (chemotherapy). Part B. Part D covers most outpatient prescription drugs (drugs you fill at the pharmacy). Check your plan’s list of covered drugs to find out whether it covers the drugs you need. What should I do if I am having trouble accessing my medication? Call 1-800-MEDICARE to find out whether your drug should be covered by Part A, B, or D. Ask your pharmacist or provider to submit claims to the correct part of Medicare. If your provider is unsure of how to submit these claims, they can call your plan or Medicare for assistance. • Part D drug: they should call your Part D plan. • Part B drug and you have a Medicare Advantage plan: they should call your Medicare Advantage plan. • Part B-covered drug and you have Original Medicare: they should call the Medicare Administrative Contractor (MAC) for your region. For Arizona, the A/B MAC is Noridian at 877-908-8431. Part D cannot pay for any of your drugs that are covered by
©2019 Medicare Rights Center | www.medicareinteractive.org | The Medicare Rights Center is the author of portions of the content in these materials but is not responsible for any content not authored by the Medicare Rights Center. This project was supported, in part by grant numbers 90SAPG and 90MPPG from the U.S. Administration for Community Living (ACL), Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy.
Page 24 | July/August 2019, Never Too Late
Pima Council on Aging
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