If you are receiving injectable medications, it's very important to consider how those medications are billed through Medicare. Here's a cost saving tip: Injections that can be ordered and billed through your doctor can save you money.
For instance, your doctor might prescribe "Prolia" injections as a medical necessity for osteoporosis. The injections may be covered under Part B or Part D. BUT the cost to you will vary depending on how you obtain the medication.
Getting Your Injection Through Part B
To be covered under Part B: Medicare pays for prescription drugs administered in physicians' offices or hospital outpatient clinics. The shot must be ordered by the provider and administered in the doctor's office or other healthcare setting or by a visiting nurse.
Cost: For people who are on Original Medicare and Medicare Supplement/Medigap plan, you must satisfy the annual Part B deductible ($257 for 2026) and then you pay zero. If you are on a Medicare Advantage plan, the plan pays the 80% and you pay the 20%.
Getting Your Injection Through Part D
Coverage under Part D: The doctor will provide a prescription order for the medication which you pick up at the pharmacy. Prolia is billed through your prescription drug plan.
Cost: Your cost will be based on however your prescription plan covers the medication. You'll pay anywhere from your plan's copay to thousands of dollars out-of-pocket depending on which phase of the Part D benefit you're currently in. Part D prescription plans all differ in co-pays, so we urge you to consult your plan to prepare for the costs. Also work directly with your doctor to see if they can obtain certain injectable medications for you so they can be billed through Part B.
We are always looking for ways to help you save with your Medicare. If you need tips and hints please call us for guidance.
By Sharon Groves
Sharon Groves covers health, wellness, and lifestyle topics for the ARA newsletter, helping readers make informed decisions about their wellbeing in retirement.
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Easy Eddie's Take
Sharon's hit on something that catches a lot of people off guard. The same exact Prolia injection can cost you $30 or $3,000 depending on whether it goes through Medicare Part B or Part D. Here's what I see happening: Many people don't realize they have a choice in how they get their injectable medications like Prolia, Eylea, or Humira.
The key question to ask your doctor is: "Can you order this injection and give it to me in your office instead of sending me to the pharmacy?" If they can administer it in their office, it goes through Part B, and after you meet that $257 deductible for 2026, your Medicare Supplement plan typically covers the rest. But if you pick it up at the pharmacy, you're dealing with Part D's coverage phases, including that dreaded coverage gap where you might pay 25% of the drug's full cost.
Most people are surprised when they learn this, but it's one of those Medicare quirks that can save you serious money once you know about it.