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).
Important 2025 Part D Updates – Starting in 2025, Medicare Part D prescription drug coverage will include significant changes: the removal of the Coverage Gap (“donut hole”), a new $2,000 annual out-of-pocket maximum, an optional Medicare Prescription Payment Plan to help manage costs, and updates to Advantage MD’s prescription drug coverage. Watch the video to learn how these updates can help you prepare for the year ahead!
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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