FALSE. Different types of medications are handled by different segments of the Medicare program. Medications are typically covered under either
Part B or
Part D. Ask your doctor or the office staff under which segment of Medicare your medication will be handled.
Medicare Part B
A medication that is given intravenously is usually administered in a physician’s office or hospital outpatient clinic. Therefore, it is reimbursed under Part B (the medical insurance part of Medicare), and you would typically pay the first $162 yearly deductible and then 20% of any remaining Medicare approved amount for the service.
If you have a supplemental policy, it may pay the 20% and in some cases, depending on the plan, the annual deductible.
VELCADE® (bortezomib) is administered intravenously, and is therefore typically covered under Medicare Part B.
Medicare Part D
Other types of medications may be covered under Medicare Part D, the Medicare prescription drug benefit. The Part D benefit for 2011 includes an annual deductible, monthly premiums, co-insurance, a coverage gap, and catastrophic coverage.
In 2011, the standard prescription drug benefit works this way: you have to pay an annual deductible of $310. You then move into a co-insurance category until you reach $2,840 in covered Part D drug spending. Your insurance plan pays 75% of the cost of the medication in this category, and you are responsible for paying 25% (up to a maximum of $632.50).
From there, you go into what is referred to as the "coverage gap" or "doughnut hole" for the next $3,607.50 in covered Part D drug spending. Prior to 2011, you would have paid 100% of the cost within the coverage gap. Starting in 2011, eligible Medicare Part D beneficiaries whose spending on Part D prescription drugs enters them into the coverage gap will receive a 50% manufacturer discount on the total cost of brand-name drugs and a 7% government subsidy on the total cost of generic drugs within the coverage gap.
Once you get out of the coverage gap (generally after $6,447.50 in covered Part D drug spending), you are in what is referred to as “catastrophic coverage.” You will now be responsible for paying 5% of the cost of your drug. The prescription drug benefit described above starts over at the beginning of each year.
| Benefit Phase |
Beneficiary Cost-Sharing Percentage |
Maximum Beneficiary Out-of-Pocket (OOP) Costs per Phase |
Plan Payment Percentage |
Plan Payment |
Annual Deductible
$0 - $310 in spending on covered Part D drugs
|
100% |
$310 |
0% |
$0 |
Initial Benefit
$310.01 - $2,840 in spending on covered Part D drugs
|
25% |
$632.50 |
75% |
$1,897.50 |
No coverage of costs
$2,840.01 - $6,447.50 in spending on covered Part D drugs*
|
100%* |
$3,607.50* |
0% |
$0 |
|
Catastrophic Coverage after patient OOP costs on covered Part D drugs exceed $4,550; generally equivalent to $6,447.50 in covered Part D drug spending
|
5% |
Unlimited |
95% |
Unlimited |
*Starting in 2011, eligible Medicare Part D beneficiaries whose spending on Part D prescription drugs enters them into the coverage gap will receive a 50% manufacturer discount on the total cost of brand-name drugs and a 7% government subsidy on the total cost of generic drugs within the coverage gap.