Covering the Bases: Use Part D to pay for shingles vaccine | Maryland Gazette (HometownGlenBurnie.com)

Your will need to work through your Part D plan. According to the Centers for Medicare and Medicaid Services, you will pay the least for your vaccination if you are vaccinated at a doctor's office that can work with a pharmacy that will bill your Part D plan for the entire cost of the vaccination process, or if the office can bill for the vaccine directly using a special computer billing system that is available. This billing system is run by a company called Dispensing Solutions.

Otherwise, it is likely that the doctor will bill you for the entire cost of the vaccination or will ask you to pay up front when you receive the vaccination.

You will then need to follow Part D plan rules to apply for a reimbursement. There is no limiting charge for the vaccine, so your plan will only reimburse you for the approved amount of the vaccine cost. You will be responsible for the difference between the doctor's charge and the plan's approved amount.

Where can I get a list of the Medicare-approved drugs for Part D plans?

There isn't one specific list of drugs covered under Medicare Part D. Part D is offered by private plans that negotiate prices with the individual drug companies, so the availability of drugs will vary from plan to plan.

Each plan has its own formulary, or list of drugs that are covered.

Medicare law requires that each plan offer at least two drugs in each therapeutic class of drugs, so you can be assured that your Part D plan will have a drug that your physician could prescribe for your condition.

However, the drug your physician prefers may not necessarily be included on your drug plan's formulary at this time, so you'll need to discuss issues such as generic substitutes with your physician.

Sometimes my outpatient services under Medicare are subject to a co-payment, and sometimes they're not. What's the difference?

Doctor's services, outpatient medical and surgical services and supplies, diagnostic tests, ambulatory surgery center facility fees and durable medical equipment are examples of services that have a co-payment of 20 percent of the Medicare-approved amount.

Clinical laboratory services such as blood tests and urinalysis are not subject to a co-payment, and this is probably what you have noted as a difference.

Your Medicare Summary Notice (MSN) is your best guide to understanding how Medicare covers your medically necessary services. An MSN will show you which services are subject to a deductible or co-payment.

If you have a Medigap or other secondary plan, these charges can be referred to that company for consideration of payment.

Susan Knight is a senior health insurance consultant. If you have questions about the information in this column, contact the county's Senior Health Insurance Program at the Department of Aging and Disabilities at 410-222-4464 or ship_program@aacounty.org.