How Medicare covers self-administered medications given in hospital outpatient settings:
If you have Medicare coverage, your hospital care as an inpatient is covered by Medicare Part A. If you are in Pella Regional Health Center as an outpatient (emergency department, surgery center, and observation care) your care is generally covered by Medicare Part B. However, Medicare Part B covers only certain medications in these settings, like medications given through an IV (intravenous infusion).
There may be times when you are in the hospital as an outpatient and will need “self-administered medications.” These are medications that you would normally take on your own such as tablets, capsules, inhalers, eye drops and liquids.
Medicare Part B generally doesn’t pay for “self-administered medications.” The medications that are not covered in an outpatient setting will be billed to you and you will need to pay for them out-of-pocket.
Non-covered medications may be reimbursed through your Medicare Part D plan:
If you have Medicare Part D (Medicare medication plans), the medications you receive as an outpatient that are not covered by Medicare Part B can be submitted to your Medicare Part D plan. Reimbursement will depend upon whether the medications you received are included in the Part D plan formulary.
Pella Regional Health Center does not participate in the Medicare Part D program. Therefore, you will need to submit a claim for non-covered medications to your Part D plan. You should follow the drug plan enrollment materials or call the Medicare Part D phone number listed on the insurance card for information about submitting a claim. If you need assistance or specific information to complete the forms, the Business Office at Pella Regional will help you complete those forms.
Can I use my own medications from home?