Prescription Medications During an Outpatient Hospitalization (plan, surgery, coverage, Medicare)

[PawleysDude]

I have Medicare Part A, B and D coverage. I am scheduled for minor surgery that will be done on an outpatient basis, but kept overnight for observation. The hospital has a list of my regular prescription medications, and I assume they will want to administer them. Since I am not inpatient, Part A is not involved. Since Part B does not cover prescription drugs, how are these drugs covered? Do I get stuck with the bill? Thanks for any feedback.

[Prumio]

My hospital always "admits" as inpatient for day surgeries, even when the expected outcome is for the patient to go home within hours of the procedure. Are you completely sure that your status will be "outpatient"?

[reed303]

As with most things with Medicare, the "devil is in the details." Starting with what specific drugs are involved.

You could start to understand the issues by reading page 52 of the "Medicare and You " handbook at https://www.medicare.gov/pubs/pdf/10...re-and-You.pdf

Then follow its instruction to "Contact your prescription drug plan to find out what you pay for drugs
you get in a hospital outpatient setting that aren’t covered under Part B".

[SCGamecock]

This CMS article on outpatient hospital drugs should answer your questions.
https://www.medicare.gov/Pubs/pdf/11333.pdf

[PawleysDude]

Thanks for all the feedback. I had previously discussed this issue with the hospital and my Part D provider. Hospital confirmed my status will be outpatient. My Part D provider confirmed the hospital pharmacy is not a "preferred provider", so Part D coverage will reimburse only the price I pay to my preferred provider. Since many are generic, in most cases the reimbursement will be $0. It's pretty much a lose/lose situation and Medicare does not approve appeals for this situation.

For the record, I was finally able to talk with someone in the hospital business office who gave a damn. She confirmed the situation to be exactly how it is described by Medicare and my Part D provider. She also confirmed the cost of the drugs billed to me will be significantly higher than $0. The hospital also does not allow me to bring my own drugs. They will administer them, bill Medicare who will reject the self-administered drugs portion, and the hospital will bill me. She also told me if I would call her when that happens, they will excuse the charge, but only if I call and complain. In the long run, I guess that's the bottom-line answer I was looking for, but it seems to be a sad reflection of the state of health care in the US.

Thanks again for all the comments.