Medicare drug coverage

Rely on our team to help you understand the cost of your prescriptions and medical services from Montage Health and Community Hospital of the Monterey Peninsula. If you have Medicare, get answers to common questions about medication coverage and costs. Call your Medicare plan provider and check your Medicare Handbook for specific information about your coverage.

Part D coverage

Community Hospital is not a Medicare Part D provider and cannot submit a claim for payment. This means, if you have Medicare Part D, you may need to pay-out-of-pocket for medications and then submit a claim to your drug plan for reimbursement (repayment).

We will mail you an itemized statement detailing the self-administered medications you received. You can then send that bill to your Medicare Part D carrier.

What are self-administered drugs?

Self-administered drugs are typically prescription and over-the-counter drugs you may receive in an outpatient setting. Outpatient means you visit the facility for same-day care. Settings include:

• Emergency department
• Outpatient departments, such as [examples]
• Clinical decision unit, which allows doctors to monitor patients who may not be admitted to the hospital for inpatient care but aren’t ready to go home

Does my plan cover self-administered drugs?

Medicate Part B doesn’t cover self-administered drugs. To prevent you from having a financial burden, Community Hospital will absorb (cover) charges for medications denied by Medicare Part B.

If you have Medicare Part D coverage, self-administered drugs may be covered under certain circumstances.

What if I had an inpatient stay?

You may not meet Medicare criteria for prescription coverage if you stayed overnight at the hospital. The federal criteria is based on inpatient level of care standards and defined by Medicare.

Non-administered medication

If your doctor orders a medication but for some reason you don’t receive it, you won’t be charged for the medication.

Hospital pharmacy drug prices

Rest assured, Community Hospital aims to make healthcare services, including medications, affordable and accessible.

You may notice that some medications from the hospital pharmacy are more expensive than similar medications from a retail pharmacy. That’s because overhead costs of a hospital are higher than a retail pharmacy. A hospital is always open and staffed by doctors, nurses, and other clinical support staff members caring for very sick patients and available for emergency situations. Our pricing is based in part on the cost of the medication and the way it’s given.

Generic versus brand name drugs

Community Hospital uses generic medications in some cases and brand names in others. The medications we use are mostly purchased through a group contract to achieve the best prices.