B vs D in Medicare Advantage

[Guest guest]

Below is an excellent “plain language” description from one of our local MA plan booklets of the coverage for B and D drugs. The only thing missing is the detail that B drug OOP will help satisfy the Medical OOP max. As the “plain language” initiative takes hold nationwide I hope we’ll see more of this in plan booklets from all payors. on Transplant Financial Coordinator Legacy Good Samaritan Hospital Legacy Transplant Services 1040 NW 22nd Ave Ste 480 Portland OR 97210 direct main office toll-free fax lmorriso@... Prescription Medication BenefitsServices that are covered for youWhat you must pay when you get these services In-networkWhat you must pay when you get these services Out-of-networkDeductible - Combined in and out-of-networkDeductible applies to all services except the following:Preventive care and screening testsPreventive dental servicesRoutine vision exam, eyeglasses, contact lensesMedicare Part B prescription drugsClassic Plan: $50Services that are covered for youWhat you must pay when you get these services In-networkWhat you must pay when you get these services Out-of-networkMedicare Part B prescription drugs Prior authorization is required for in-network servicesThese drugs are covered under Part B of Original Medicare. Members of our plan receive coverage for these drugs through our plan. Covered drugs include: Drugs that usually aren’t self-administered by the patient and are injected or infused while you are getting physician, hospital outpatient, or ambulatory surgical center services Drugs you take using durable medical equipment (such as nebulizers) that was authorized by the plan Clotting factors you give yourself by injection if you have hemophiliaImmunosuppressive Drugs, if you were enrolled in Medicare Part A at the time of the organ transplantInjectable osteoporosis drugs, if you are homebound, have a bone fracture that a doctor certifies was related to post-menopausal osteoporosis, and cannot self-administer the drugAntigensCertain oral anti-cancer drugs and anti-nausea drugsCertain drugs for home dialysis, including heparin, the antidote for heparin when medically necessary, topical anesthetics, and erythropoisis-stimulating agents (such as Epogen®, Procrit®, Epoetin Alfa, Aranesp®, or Darbepoetin Alfa) Intravenous Immune Globulin for the home treatment of primary immune deficiency diseasesChapter 5 explains the Part D prescription drug benefit, including rules you must follow to have prescriptions covered. What you pay for your Part D prescription drugs through our plan is listed in Chapter 6.Immunosuppressive DrugsClassic Plan:10% coinsuranceAll other Part B drugsClassic Plan: 20% coinsuranceImmunosuppressive DrugsClassic Plan:10% coinsuranceAll other Part B drugsClassic Plan: 20% coinsurance