As of October 2021, nearly 64 million Americans were enrolled in Medicare, and since the agency’s beginnings in 1965, many have come to rely on Medicare services to cover their treatments. Patients undergoing infusion therapy are covered under Medicare. However, new guidelines for Medicare coverage, which went into effect in 2021, could still have some enrollees confused about how much of their home infusion is covered. Today, we’re taking a detailed look at Medicare coverage and home infusion.
Medicare covers quite a lot of expenses related to home infusion. Original Medicare specifically covers home infusion under Medicare Part B, where plans pay for 80% of therapy costs. Medicare Advantage plans must cover at least as much as Original Medicare; however, the actual percentage covered varies by case. Unfortunately, Medicare Supplement plans which are the plans that pay for out-of-pocket costs not covered by Medicare, do not usually cover home infusion.
Before beginning the enrollment process, it’s essential to know whether or not you qualify for Medicare coverage. To qualify, you must meet these requirements:
- You must have a condition requiring home infusion and an established diagnosis of that condition.
- Have a referral from your doctor.
- The home infusion provider you choose must be Medicare-approved.
- Any equipment purchased for home infusion must be from a Medicare-approved supplier.
- You must pay your Medicare monthly premiums and satisfy any deductible your plan may have.
In 2016, Medicare announced that home infusion therapy would be covered under Medicare Part B effective January 1, 2021. Medicare Part B, which we mentioned previously, covers all of the supplies used for home infusion, such as IV poles, tubing, pumping, etc. Medicare also announced that they would now cover some of the drugs used for home infusion under the guidelines that they were intravenous or IV treatments with infusions lasting for at least fifteen minutes. Part B also covers the fees from your infusion provider for at-home infusion treatments.
At ContinuumRx, we work with patients to ensure they get the maximum coverage for their infusion therapy, whether it be from home or one of our comfortable infusion suites. If you have questions about your Medicare coverage for home infusion, contact your ContinuumRx Patient Care Representative or contact Medicare directly. Are you interested in starting infusion therapy? Contact us today to learn more!