If you are on Medicare,你很可能依赖D计划你的处方药保险。如果你有一定的健康状况,您甚至可能不知道您的某些药物包含在B部分中。事实上,您可以感谢B部分涵盖了成人接种疫苗你收到了。

That may be about to change.With medication costs rising every year,迫切需要为需要这些药物的人降低成本。为此,the Trump administration has put forth a plan called"American Patients First."Several parts of the plan will change how Medicare pays for your medications.Part of their plan is to move Part B coverage into Part D.这可以为医疗保险计划本身节省数百万美元,但这对您未来的医疗保健意味着什么??


无论你选择原医疗保险(A部分和B部分)或医疗保险优势(C部分)计划,you have access to medications covered by Part B.其中许多药物仅限于具有特定医疗条件的人。以下列表并不包含所有内容,但对所有涵盖的B部分类别进行了审查。


  • 化疗药物*
  • 作为化疗方案的一部分的抗恶心药物*
  • Immunosuppressive medications for people who have had an organ transplant that was covered by Medicare
  • 用于终末期肾病


  • 抗原(例如,,allergy shots) that are prepared by a physician and administered by a trained individual
  • Blood-clotting factors for people with血友病
  • 红细胞生成-对患有与某些医疗条件相关的ESRD或贫血的人使用刺激剂。
  • 静脉注射免疫球蛋白(IVIG)治疗原发性免疫缺陷病
  • Osteoporosis绝经后骨质疏松骨折妇女用药
  • 由持有执照的医疗专业人员(例如,用于治疗的生物制剂inflammatory bowel disease,,银屑病,和类风湿关节炎)*
  • 肠外营养(iv)或tube feedsfor people who cannot take food by mouth or absorb nutrition in their GI tract


Medical Equipment Used to Administer Medications

  • 输液泵
  • 喷雾机

*口服化疗和抗恶心药物必须符合B部分所涵盖的某些标准。While the majority of injectable medications will be covered by Part B,keep in mind that some drugs may be excluded.覆盖要求每年都会发生变化。




At a minimum,Part D plans are required to cover at least two medications in each therapeutic drug class.其中六个班级-antidepressants,抗精神病药,化疗药物,,HIV/AIDS药物,immunosuppressants,和癫痫药物-几乎所有的药物都会被覆盖。

D部分计划也不能向你收取超过这些药物零售成本25%的费用。如果您需要更广泛的计划或涵盖特定药物的计划,you may need to do some searching.您可能会支付比2019年每月32.50美元的基本保险费更多的费用。

Simply put,D部分包括B部分留下的内容。如果有人进行了不在医疗保险范围内的器官移植,their immunosuppressant drugs would be covered by Part D,not Part B.如果有人想要乙肝疫苗,但被认为是低风险的,they would have to turn to their Part D coverage.

How Parts B and D Work Together


Medications you receive in the hospital when you areadmitted as an inpatient将由您的Part A deductible.It is important to understand what happens when you are evaluated in the emergency room and sent home or are处于观察状态,即使你在医院过夜。In this case,you can turn to Parts B and D to pay for your drugs.

When you are placed under observation,B部分仍将支付上述审查药物的费用。如果你接受静脉注射药物,这些通常会被涵盖。However,you may also receive oral medications during your observation stay that are not on the Part B list of approved medications.In this case,you will be billed for each pill administered by the hospital.

Send copies of your hospital bills to your Part D plan for reimbursement.不幸的是,if you receive a medication that is on your Part D formulary,你的计划可能不值得。


医疗保险支付给医生办公室使用的药物的费用有点不同于从药房获得的药物。Your doctor purchases these medications in advance.Because their office is responsible forstoring these medications and preparing them for use,医生的报酬是药品批发采购成本的6%。他们是单独支付,以实际管理药物。

Concerns have been raised that some doctors may have been abusing the system,为了赚钱而订购最贵的药物。因为病人仍然需要支付20%的治疗费用,这也增加了患者的现金支出。

医疗保险和医疗补助服务中心(CMS)希望结束这种局面。A proposal has been made for 2019 that would reduce the add-on cost to 3 percent for new prescription drugs.到目前为止,CMS覆盖的药物将继续以6%的费率支付。


Merging Medicare Parts B and D


第一,并非所有的医疗保险受益人都单独购买D部分保险或作为医疗保险优势计划的一部分。多达27%的人没有。In order to gain drug coverage,这项建议将要求他们购买D部分计划并每月支付保费。With basic premiums costing $32.50 per month in 2019,这将增加每年390美元的医疗费用给那些可能负担不起的人。Keep in mind that does not include the cost of copayments or coinsurance.

第二,it is unclear if all medications or only a select group of drugs would be included in this proposal.对于那些需要频繁静脉注射药物的人来说,可能会有重大影响,尤其是用于自身免疫和风湿病的生物制剂。

对于B部分以下的人来说,这些药物可能更便宜,especially since Part D plans can charge expensive copayments or coinsurances for在处方上使用更高级的药物.They may even require事先授权或者选择不包括某些药物。




Although you cannot negotiate with the pharmaceutical companies yourself,您的医疗保险优势计划可能能够代表您这样做。直到最近,,只有医疗补助和退伍军人健康管理局能够做到这一点。.现在,CMS将允许医疗保险优势计划谈判医疗保险B部分涵盖的药品价格。这将于2019年生效。

医疗保险优势计划将通过使用阶梯疗法来降低成本。In this scenario,如果第一次治疗无效,你的计划可能要求你在选择更昂贵的替代方案之前尝试一种更便宜的药物。Private insurance plans that have used this model have achieved discounts of 15 to 20 percent whereas Medicare has paid full price.这就要改变了。

阶梯疗法也会影响你在D部分药物上的花费。This is because the less expensive medication options recommended by your plan are more likely to be on your Part D formulary.目标是让你的医疗保险优势计划控制成本。它将通过将成本转移到低成本的D部分替代品,而不是更昂贵的医生使用的B部分药物来实现这一目标。


并不是每个人都意识到他们得到了医疗保险处方药覆盖B部分和D部分。Understanding how these programs work together is helpful but it may be more important to realize what changes may be coming down the line.联邦政府正在寻求改变支付给医生使用B部分药物的方式,并可能将B部分处方药的覆盖范围合并到D部分。它还将允许医疗保险优势计划与制药公司协商B部分药物的成本。这些变化可能会影响你的现付金额。