Medicare Part B (Medical Insurance) generally covers care you get in a hospital outpatient setting, like an emergency department, observation unit, surgery center, or pain clinic. Part B covers certain drugs in these settings, like drugs given through an IV (intravenous infusion).
Sometimes people with Medicare need “self-administered drugs” while in hospital outpatient settings. “Self-administered drugs” are medications that you would normally take on your own, like medications that you take every day to control blood pressure or diabetes. In most cases, Part B generally doesn’t pay for self-administered drugs used in the hospital outpatient setting.
If you get self-administered drugs that aren’t covered by Part B while in a hospital outpatient setting, the hospital may bill you for the drug. However, if you’re enrolled in a Medicare drug plan (Part D), the plan may cover these drugs.
What you should know about Medicare drug plans (Part D) and self-administered drugs
If your Medicare drug plan doesn’t cover the drug, you need to pay what the hospital charges for the drug. As mentioned earlier, you can always request an exception if your plan tells you a drug isn’t on their formulary, or you can appeal your Medicare drug plan’s decision not to cover the drug.
Where can I get more help?
• Call your State Health Insurance Assistance Program (SHIP) to get free personalized health insurance counseling. To get the phone number for your state, visit shiptacenter.org, or call
1-800-MEDICARE (1-800-633-4227). TTY users can call
1-877-486-2048.
• For information on how to appeal any decision made by your Medicare drug plan, check your plan’s enrollment materials, or call your plan.
Information provided from:
CMS Product No. 11333
You have the right to get Medicare information in an accessible format, like large print, Braille, or audio. You also have the right to file a complaint if you feel you’ve been discriminated against. Visit
https://www.medicare.gov/about-us/accessibility-nondiscrimination-notice or call
1-800-MEDICARE (1-800-633-4227) for more information. TTY users can call
1-877-486-2048.