Medicare Part B covers outpatient services but not “self administered drugs”.  So what does that mean?

Let me share with you my experience with my mother.  She had the port in place and was ready to start her chemotherapy.  I accompanied her to the infusion center (which is an outpatient setting and covered under Part B) for her first treatment.  While we were there, a nurse handed my mother a small tube of ointment and explained that she should put a small dab of this ointment on her port the next time she comes for her treatment.

Imagine our surprise when we received a bill from the infusion center for $37.17.  When I inquired about the charge, I was told that was for the tube of ointment that they had given Mom.  The infusion center has no means to bill Medicare because they are not a Medicare Part D vendor (a pharmacy) so they billed my mom.  I was advised that I certainly could submit a claim to her Part D vendor and hope to be reimbursed.  I can assure you this is much easier said than done!

What should have happened is – we refuse the tube of ointment and ask for a prescription that we could fill at the pharmacy.  Mom didn’t need the ointment until her next treatment so there was plenty of time to run it through the pharmacy.  In that way, the same tube of ointment processes under the Part D benefits.  Lesson learned!

So, my advice is, whenever you are in an outpatient setting, ask them to write a prescription for the medication so you can have it filled at the pharmacy where it is covered under Part D.  If you are in an observation unit in a hospital, you may think you are in the hospital, but you are not.  Observation units are outpatient settings covered under Part B, and “self administered drugs” are not covered under Part B.  So take your own medications with you (or have someone bring them in).  Otherwise, you will be charged by the hospital for the medications.  Hospital observation units are not pharmacies and therefore, cannot bill for Part D services.