Important Information for Our Medicare Patients

Medicare Patients-“Self Administered Medications”

Under Medicare Part A (inpatient), drugs are covered when provided during acute inpatient stays if Medicare requirements are met. Under Medicare Part B (outpatient, Emergency Room and observation hospital stays), drug coverage is limited to drugs that are not usually self-administered.

Drugs that are covered include the following:

• One flu shot per flu season in the fall or winter
• One pneumonia vaccine (lifetime)
• Hepatitis B vaccine (series of 3 injections for any patient at risk for Hepatitis B, check with your physician) and some other vaccines (such as a tetanus shot) when they are related to the treatment of an injury or illness.
• Other drugs that are considered integral to the procedure or treatment you receive during your hospital visit.
  

During the course of outpatient treatment, you may be given medication Medicare considers self-administered. Medicare defines self-administered drugs as medications the patient could, in another setting, take themselves. The list of medications includes tablets, sprays, drops, inhalants and some injectable drugs.

In order to remain compliant with Medicare regulations related to the billing of these drugs, the hospital is required to submit these self-administered drugs as non-covered items on our billing to Medicare. You will receive a bill from the hospital following payment of our claim by Medicare. In addition to any deductible and co-insurance due, this bill will reflect the charges for unpaid self-administered drugs. Payment for non-covered items will be expected from you. With few exceptions, most secondary insurance carriers do not cover self-administered drugs.

Medications brought from home in their original pharmacy container, properly labeled and positively identified may be used with a physician order. If we are able to use your home medications, you will not receive a bill for these medications. When coming to the hospital for outpatient admission, to see a physician, receive outpatient services or use the Emergency Room, always try to bring any medication (in its original pharmacy container) you have been taking.

Your medication will be stored in the unit's medication room; please do not forget to obtain your medications prior to discharge.

If you would like additional information about your coverage by Medicare, you can call: 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov to get help with your Medicare questions.

Are You a Hospital Inpatient or Outpatient? (pdf)
Personal Health Record (doc)