Part B meds

[AgentGeneral]

As a result of thinking about a few recent meds this past month, I starting over thinking a ton.

I get it for the most part although seems like a lot of gray areas.

For instance this past month has shown me I have more to learn....Things Like Haldol, Invega for schizophrenia or Wegovy for weight loss, and other injections that can be done by anyone in their own home...if the doc or PA or NP are administering those same drugs in facility, even though then what would it fall under. Some meds are simply given in a facility due to a Dx and the doc wanting to monitor. Gets a little confusing. Any thoughts? or better yet facts?

I tried for a bit to find it online, and for the most part, what I get is "most" medications given in a facility fall under Part B. Not to informative really. "Most" doesn't really cut it esp when it could come up in a complaint, I mean what would you say, "most" drugs are ...." so there, nothing to see here, did nothin wrong....

Or is there another site I'm missing to get a full list on what EXACTLT and ALL falls under B medication wise, more specific info.

 

[sman]

As a result of thinking about a few recent meds this past month, I starting over thinking a ton.

I get it for the most part although seems like a lot of gray areas.

For instance this past month has shown me I have more to learn....Things Like Haldol, Invega for schizophrenia or Wegovy for weight loss, and other injections that can be done by anyone in their own home...if the doc or PA or NP are administering those same drugs in facility, even though then what would it fall under. Some meds are simply given in a facility due to a Dx and the doc wanting to monitor. Gets a little confusing. Any thoughts? or better yet facts?

I tried for a bit to find it online, and for the most part, what I get is "most" medications given in a facility fall under Part B. Not to informative really. "Most" doesn't really cut it esp when it could come up in a complaint, I mean what would you say, "most" drugs are ...." so there, nothing to see here, did nothin wrong....

Or is there another site I'm missing to get a full list on what EXACTLT and ALL falls under B medication wise, more specific info.

I simply tell them that "if the medication has to be administered by a medical professional it is typically covered by Medicare Part B". I also tell them if they are ever unsure, the doctor/facility who will be administering it should know as you likely aren't the first patient they've ever done this for so you can always ask them.

You should never state with 100% certainty that something is covered (in relation to Part B drugs) since you aren't the one who will be adjudicating the claim.

 

[policywunk]

I simply tell them that "if the medication has to be administered by a medical professional it is typically covered by Medicare Part B". I also tell them if they are ever unsure, the doctor/facility who will be administering it should know as you likely aren't the first patient they've ever done this for so you can always ask them.

You should never state with 100% certainty that something is covered (in relation to Part B drugs) since you aren't the one who will be adjudicating the claim.

Yes always a definite maybe when setting clients expectation how it will be billed when it comes to drugs that call come under part b or D .Sometimes the drug can be administered by a physician or in a facility and it will still be billed under part D because of how the drug was procured .

 

[somarco]

[EXTERNAL LINK] - Chemotherapy for Breast Cancer | Breast Cancer Treatment

download PDF from this link
https://www.wellcare.com/en/Providers/Medicare-Bulletins/Medicare-Part-B-Drugs-List

[EXTERNAL LINK] - List of Drugs Covered by Medicare Part B | HelpAdvisor.com

FWIW, when you encounter someone who will be taking Part B drugs for life, you need to understand how Part B drugs are covered under OM vs MAPD . . . and include that explanation in your presentation

 

[Fisher]

FWIW, when you encounter someone who will be taking Part B drugs for life, you need to understand how Part B drugs are covered under OM vs MAPD . . . and include that explanation in your presentation

That is a valid, and vital, point.

 

[AgentGeneral]

That is a valid, and vital, point.

Good thing I get that. Math is a strong suit (most the time).

Thanks for reminder.

Not a day off today, but so it's back to under-promise / over-deliver and never say 100%.

An example I've seen billed both ways was Prolia, two separate clients. There must be a rhyme or reason (maybe not though lol consider the source).

Ill stick with the Policywunk and sman answer thanks so much.

 

[AgentGeneral]

[EXTERNAL LINK] - Chemotherapy for Breast Cancer | Breast Cancer Treatment

download PDF from this link
https://www.wellcare.com/en/Providers/Medicare-Bulletins/Medicare-Part-B-Drugs-List

[EXTERNAL LINK] - List of Drugs Covered by Medicare Part B | HelpAdvisor.com

FWIW, winderstand how Part B drugs are covered under OM vs MAPD . . . and include that explanation in your presentation

Thank you. I downloaded that. I'm sure it will be useful at some point. I get Part B on an MAPD vs OM.

 

[somarco]

I get Part B on an MAPD vs OM.

In that case you will have copay's, not deductible and coinsurance.

Part B drugs covered by OM are almost always less OOP if you also have a Medigap plan.

 

[ValeRosso]

Part B drugs covered by OM are almost always less OOP if you also have a Medigap plan.

How are part B drugs covered by MAPDs? Coinsurance?

 

[straightnochaser]

How are part B drugs covered by MAPDs? Coinsurance?

20% Coinsurance