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  • Bob Vineyard

What Are Part B Drugs? – Why is the List Limited?

Bob Vineyard · February 9, 2022 · Leave a Comment

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?

Medicare Part B Drugs

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.

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.

Part B drugs

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.

Will Medicare Pay For Shingles Vaccine?

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.

Who is Georgia Medicare Plans and What Do They Do?

Medicare information. Our videos help you understand all about Medicare. You have questions, I have answers.

What is Medicare and how does it work? What is Medicare Part A, Part B, Part C and Part D? What is a Medicare Advantage plan and why is it free? What is the difference in Medicare Supplement and Medicare Advantage? Which is better? Why do I have to pay a premium for Part B Medicare? Why is Part A free but Part B is not? How can I pay my Medicare premiums? Can I use a credit card? Can the premiums be deducted from Social Security?

GA Medicare expert Bob Vineyard takes the time to LISTEN then offers ANSWERS in plain English Medicare supplement plans, Medicare Advantage vs Medicare supplement. Medicare Part A, Medicare Part B. Which Medicare plan is BEST? How to change Medicare plans? Medicare supplements plan G information and rates. Which Medicare options are best? What is original Medicare? What are Medicare basics? Turning 65 Medicare? Medicare explained.

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#DoesMedicarePartBCoverPrescriptionDrugs #WhenCanIusePartBforDrugs #IsInsulinCoveredByMedicarePartB

Georgia Medicare Plans. An offer you can’t refuse.

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Does Medicare Cover COVID Testing and Treatment in 2020?

Bob Vineyard · December 16, 2020 · Leave a Comment

Does Medicare cover COVID testing? What are COVID-19 symptoms? Is Coronavirus treatment in and out of the hospital included in Medicare? How much will I have to pay for care?

Does Medicare Cover COVID Testing and Treatment?

Coronavirus testing is included in your Medicare Part B coverage. Your cost for testing should be $0 when the test is conducted by a lab, pharmacy, doctor or hospital.

Your test should be ordered by your doctor to diagnose or rule out the COVID infection.

You, as an individual, may choose to have the screening for personal reasons. This would not be considered medically necessary and would not be covered by Medicare.

What are COVID symptoms that indicate I may be infected?

Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

Will Medicare Cover My Coronavirus Treatment in or out of the Hospital?

Seriously ill patients may need inpatient and/or outpatient services. Medicare covers inpatient hospital stays, skilled nursing facility (SNF) stays, some home health visits, and hospice care under Part A. Beneficiaries who need medical care following a hospitalization have coverage in a skilled nursing facility.

FAQ from Kaiser Foundation

You will find a wealth of information from the Washington Post. These reports are available at no charge. You do not need to register to view the articles.

Am I considered “high risk” for Contracting the Chinese Virus?

Older adults and those with compromised immune systems tend to be more susceptible to contracting the disease.

Medical conditions including high blood pressure, diabetes, COPD, and asthma can tax your immune system putting you in a higher risk category than the rest of the population.

Additional information about COVID-19 from these resources
https://www.coronavirus.gov/
https://www.usa.gov/coronavirus

CORONAVIRUS Facts to Ease Your Fears

The CDC estimates the overall fatality rate is .26%.

Ninety-four percent of COVID-19 deaths involve, on average, 2.6 additional conditions or causes of death.

Those outside of nursing homes, the infection fatality rate is estimated to be just 0.13 percent.

About one-third of Covid-19 deaths occur in nursing homes, or other long-term care facilities.

For more information visit Flatten The Fear

What do I Need to Know about the Vaccine?

Coronavirus vaccines MAY prevent you from contracting the disease. As with any medication or vaccination, there may be side effects.

You may have pain or swelling where you received the shot.

You could also experience fever, chills, tiredness or headache.

Tests indicate the vaccine may be 90 to 95% effective in preventing the virus.

It is not yet known if the vaccine will prevent you from getting sick or it merely prevents you from having symptoms of the disease. “Full” protection may require a second dose.

Questions still remain about the vaccinations. Among those include:

What COVID-19 vaccines have been approved and how do they work?

Can the vaccine give you COVID-19?

Are there some people who should NOT get the vaccination?

If I have tested positive for the illness should I still get the vaccine?

Do I still need to wear a mask or practice social distancing after getting the shot?

Should I still use hand sanitizer and wash my hands after being in public?

Do I need to avoid contact with others if I have a fever or feel sick?

Medicare telehealth video

Coronavirus and Medicare Advantage plans.

Shop and compare Georgia Medicare plans and supplement rates. Bob Vineyard, GA Medicare insurance agent. Anthem Blue Cross Medigap rates available on request. Quoted on the phone and a report sent by email.

#CoronavirusAndMedicareCoverage #DoesMedicarePayForCOVID19TestingAndTreatment #GeorgiaMedicarePlans

Medicare Supplement Plans, Georgia Medicare Plans, Senior News coronavirus, covid-19, medicare, vaccine

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