Does Medicare cover expensive shots given at doctor’s office?

Dear Toni: I am turning 65 in February, and my individual health plan has a $6,000 deductible, which I meet every year due to shots given in my eyes for macular degeneration. They cost more than $2,500 per injection. I also receive weekly allergy shots from another doctor. Does Medicare pay for injections given at a doctor’s office?

My other concern is how Medicare will pay for this charge. — Sherry from Lake Charles, La.

Dear Sherry: Most Americans do not know what is covered under Part B, which is the medical part of Medicare.

The “Medicare and You” handbook states that Medicare Part B “helps cover medically necessary doctor’s services, outpatient care, home health services, durable medical equipment, mental health services, and other medical services.”

So if your macular degeneration injections and allergy shots are medically necessary, then Medicare will pay for those procedures under Part B. Your out-of-pocket amount is the current year’s Part B deductible. For 2024, the Part B medical/doctor deductible is $240, with Medicare paying 80 percent of the approved amount and you paying 20 percent.

Additionally, always verify that your prescriptions — including your medical injections — are also covered on your Medicare Part D plan if for some reason Medicare will not allow the shots to be covered during an office visit.

In the handbook, it states that Medicare covers medically necessary doctor services (including outpatient services and some doctor services as a hospital inpatient) and covered preventive services. Medicare also covers services from other health care providers such as physician assistants, nurse practitioners, social workers, physical therapists and psychologists.

To help pay for the out-of-pocket costs, many Medicare beneficiaries choose a supplement plan.

The Medicare handbook states that “if you are in a Medicare Advantage Plan (like an HMO or PPO) or have other insurance, your costs may be different. Contact your plan to find out the costs.” You should verify if your Medicare Advantage plan will cover your injections or if they will be covered by your Part D plan.

Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.