Important Information Cost Sharing for Medicare Part B Drugs in an Outpatient Setting

Date Issued: 9/4/2013

Beginning January 1, 2014, Medicare members will be responsible for paying 20 percent of the cost for all covered Part B drugs administered in an outpatient hospital, outpatient facility or practitioner’s office. This policy is part of the Medicare member’s required medical benefit cost-sharing and is outlined in the Evidence of Coverage.

EmblemHealth Medicare plans also provide coverage for Medicare Part B drugs, such as certain oral cancer drugs and drugs used with some types of durable medical equipment (like nebulizers and external infusion pumps). These medications are also subject to a 20 percent cost-share for Medicare members.