Medicare Part B drug coverage

Mary Carol – Texas: I now get an expensive drug that is injected at my doctor’s office. It is covered under Part B of Medicare, and my Medigap supplement plan pays what Part B does not completely pay. Is it possible that this medication will fall under Part D next year, and how will I know whether I will be able to afford it?

Phil Moeller: The fact that you get these injections at your doctor’s office is what permits the drug to be covered under Part B. Your private insurance plans – Part D and Medigap – do not set those rules. Medicare does. So, if Part B covers this drug, your Medigap plan is obligated to help pay for it.

Assuming Medicare does not change its Part B coverage rules, your exposure to these costs will be similar to what it is now. However, in the slim chance that the coverage for this drug does change, you will be able to find out details about next year’s Part D drug plans beginning on Oct. 1 of the prior year. The plans must provide you details about prices and coverage details. Medicare’s online Plan Finder also should have this information. You then could decide whether to change your coverage during Medicare’s annual open enrollment period, which runs every year from Oct. 15 through Dec. 7.