Medicare Parts B and D Coverage
Johns Hopkins Advantage MD covers both Medicare Part B and Part D* medications. To see examples of Part B medications and Part D medications and where to obtain the medication, view the Medicare Part B vs. Part D chart below.
Diabetes testing supplies are covered under Medicare Part B. Supplies like meters, lancets, and test strips can be purchased at a network pharmacy for Advantage MD (PPO) and Advantage MD (HMO) members, but nebulizers and other equipment must be purchased through a Durable Medical Equipment (DME) vendor. Advantage MD HMO D-SNP members must purchase diabetes testing supplies through a DME vendor.
If you have any questions, call Customer Service.
PPO members: call 877-293-5325 (TTY: 711).
HMO members: call 877-293-4998 (TTY: 711).
If you previously purchased diabetes testing supplies from a pharmacy without using your Advantage MD insurance, you may file a Part B claim to go through the reimbursement process.
Important Message About What You Pay for Part B Drugs – Johns Hopkins Advantage MD (HMO/PPO) members will pay less for many Part B drugs. The decrease in price will affect Part B rebatable drugs that have increased at a rate faster than the rate of inflation. Changes to co-insurance amounts are subject to change each quarter. Advantage MD will not charge more than $35 for one-month’s supply of insulin furnished through an item of durable medical equipment (example: insulin pump).
Medicare Part B vs. Part D
| Medications Covered by Part B (medical) | Medications Covered by Part D (pharmacy) | Where to Obtain Medication | |
| DiabetesSupplies | |||
| Diabetes Supplies | 1. Blood glucose self-testing equipment and supplies (whether or not you use insulin):
2. Insulin pumps and the insulin used in the pumps |
1. Injectable insulin not associated with the use of an insulin infusion pump
2. Certain diabetic supplies:
|
Advantage MD (PPO) and Advantage MD (HMO) members may obtain Part B diabetes testing supplies from an Advantage MD DME provider or any network pharmacy. Advantage MD HMO D-SNP and Advantage MD Tribute members may only obtain Part B diabetes testing supplies from an Advantage MD DME provider.
To learn about how to get diabetes testing supplies, call Customer Service. PPO members: call 877-293-5325 (TTY: 711). HMO members: call 877-293-4998 (TTY: 711). Part D diabetes supplies are available from a pharmacy. |
| Vaccines | |||
| Vaccines | Influenza (flu) and pneumonia vaccines are covered by Part B. For other vaccines, if it is directly related to an injury (such as if you stepped on a nail) or risk level, Part B covers the vaccine. | If your doctor prescribes the vaccine for a reason other than exposure or injury, Part D covers the vaccine and its administration. For example, Shingles vaccine is covered by Part D. | You may obtain Part D vaccines from your pharmacy.
You may obtain Part B vaccines from your provider or a pharmacy. Advantage MD Tribute members may only obtain Part B vaccines from an Advantage MD provider. Refer to Chapter 6 of your EOC for more information. This may require a coverage determination. |
| Inhaled Nebulizer Medications (those that you take by inhaling) | |||
| Inhaled Nebulizer Medications (those that you take by inhaling) | Medications are covered by Part B when used with a nebulizer in the home. | Medications are covered by Part D when used with a nebulizer in a skilled nursing facility or as an inpatient in the hospital and your stay is not covered by Part A. | You may obtain the medication from your provider or a pharmacy. This may require a coverage determination.
Advantage MD Tribute members may only obtain Part B drugs from an Advantage MD provider. |
| Immunosuppressive Medications | |||
| Immunosuppressive Medications | If you have received a Medicare covered transplant, medications are covered by Part B. | If you received a non-Medicare covered transplant or are using these medications for another reason, they would be covered by Part D. | You may obtain the medication from your provider or a pharmacy. This may require a coverage determination.
Advantage MD Tribute members may only obtain Part B drugs from an Advantage MD provider. |
| Oral Anticancer Medications | |||
| Oral Anticancer Medications | If you are being treated for cancer by an oral anti-cancer drug that was once available only in an injectable form that was covered by Medicare, medications are covered by Part B. | If you are using an oral anti-cancer drug that was once available only in an injectable form that was covered by Medicare for another reason, they would be covered by Part D. | You may obtain the medication from your provider or a pharmacy. This may require a coverage determination.
Advantage MD Tribute members may only obtain Part B drugs from an Advantage MD provider. |
| Oral Anti-Emetic Medications | |||
| Oral Anti-Emetic Medications | When used to treat nausea related to cancer chemotherapy (in place of intravenous anti-emetic drugs) within 48 hours of chemotherapy, medications are covered under Part B. | For all other indications or when used more than 48 hours after chemotherapy, medications are covered under Part D. | You may obtain the medication from your provider or a pharmacy. This may require a coverage determination.
Advantage MD Tribute members may only obtain Part B drugs from an Advantage MD provider. |
| Total Parenteral Nutrition (TPN) Medications | |||
| Total Parenteral Nutrition (TPN) Medications | When used to treat permanent dysfunction of the digestive tract, medications are covered by Part B. | For all other conditions, medications are covered under Part D. | You may obtain the Part B medication from your provider and the Part D medication from a pharmacy. This may require a coverage determination. |
| Erythropoietin (EPO) | |||
| Erythropoietin (EPO) | Part B covers EPO products:
|
Part D covers EPO products for:
|
You may obtain the medication from your provider/dialysis center or a pharmacy. This may require a coverage determination.
Advantage MD Tribute members may only obtain Part B drugs from an Advantage MD provider. |
| Infusible/Injectable Medications | |||
| Infusible/Injectable Medications | Medications that are administered at home that require the use of an infusion pump (as specified by the local DME provider) are covered by Part B. | Medications that do not require the use of a pump (as specified by the local DME provider) or for settings that are not considered a patient’s home (such as a long-term care home with skilled nursing on site) are covered by Part D. | You may obtain the Part B medication from your provider and the Part D medication from a pharmacy. This may require a coverage determination. |
*Part D is not available for Advantage MD Tribute members.
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