Reimbursement rate for social security medication category A, B and C

Category A drugs are reimbursed at a rate of 100%;

Category B drugs are generally paid 10% by the person concerned, and the remaining 90% can be entered into the basic medical expenses according to regulations;

and Category C drugs are generally paid by the person concerned.

This is determined by local regulations.

What are the reimbursement rates for Medicare Part A and Part B?

Basic medical insurance national drug catalog will be divided into three categories of drugs: the first category A, can all enter the scope of reimbursement, according to the proportion of reimbursement of medical insurance; the second category B, with this type of drugs need to be part of the cost of the individual first according to a certain percentage of the remaining part of the scope of reimbursement of the medical insurance, reimbursement according to the proportion of the medical insurance; the third category C, the part of the drug is not reimbursed, all by the individual. Therefore, for category A drugs in general, in addition to the items that must be deducted, the other reimbursement at 100%; category B drugs only reimburse part of the 70%-80%, self-financed drugs need to be borne entirely by themselves. That is, 15% of the total cost of the costs not related to health insurance, is the so-called category C costs are all paid in cash. Reimbursement amount = (total cost - starting line - Class B out-of-pocket expenses - full out-of-pocket expenses) x reimbursement rate.

Difference between Medicare Part A and Part B?

Category A drugs refer to those drugs that have been uniformly formulated by the state, are necessary for clinical treatment, are widely used, have good therapeutic effects, and are low-priced in the same category. Costs incurred for the use of such drugs are included in the scope of the basic medical insurance fund, and are paid for in accordance with the provisions of the basic medical insurance scheme. Class B drugs are drugs that can be used for clinical treatment, have good therapeutic effects, and are more expensive than Class A drugs in the same category.

Medicare Class B refers to Class B drugs, drugs for which the basic medical insurance fund has the ability to pay part of the cost. Costs incurred by the use of such medicines are first paid by the insured person as a certain percentage of the cost, and then included in the scope of the basic medical insurance fund and paid for in accordance with the provisions of the basic medical insurance.

Legal basis

The Social Insurance Law of the People's Republic of China

Article 26 The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.