Does Medicare Cover Home Infusion Therapy?
- Get the facts about Medicare coverage for home infusion therapy. Learn about the guidelines, and find out what parts of therapy Medicare is unlikely to cover.
The National Home Infusion Association reports that 3.2 million people receive home infusion therapy each year. In 2021, new guidelines for Medicare coverage for this commonly used at-home treatment went into effect. If you're enrolled in Medicare, understanding the rules will help you better anticipate the cost of your care and increase the chances that your therapy will be covered by your plan.
Does Medicare Cover Home Infusion Therapy?
Medicare typically covers many expenses related to home infusion therapy. To qualify for coverage, you must:
- Have an established diagnosis of a condition that requires home infusion
- Receive a referral from your doctor
- Choose a home infusion therapy supplier approved by Medicare to perform home infusions
- Purchase any equipment that you keep at home from a Medicare-approved supplier
- Pay your monthly Medicare premiums
- Satisfy any deductible that your plan has
What Is Home Infusion Therapy?
Home infusion therapy is the term for receiving a drug intravenously at home. Depending on the type of medication, a needle or a catheter will be used. The therapy allows you to undergo treatment for a medical condition or illness at home rather than in a hospital setting. All home infusion therapy is done by a medical professional — usually a registered nurse. Drugs that you can administer on your own via a simple injection don't qualify as home infusion therapy.
What Conditions May Require Home Infusion Therapy?
Some conditions that may require home ongoing infusion therapy include:
- Autoimmune disorders such as multiple sclerosis and rheumatoid arthritis
- Congestive heart failure
- Gastrointestinal disorders
- Immune system deficiencies
- Neurological disorders
You may also need infusion therapy for a short period of time while recovering from:
Which Part of Medicare Covers Home Infusion Therapy?
With Original Medicare, home infusion therapy falls under Medicare Part B. Medicare classifies the supplies needed for treatment as durable medical equipment. Under Medicare Part B, your plan pays for 80% of the cost of home infusion therapy. The remaining 20% of expenses related to home infusion therapy are your responsibility.
What Will Medicare Part B Cover for Home Infusion Therapy?
Medicare Part B typically covers all the supplies required for home infusion therapy, such as:
- IV stands and poles
- Pumps (excluding insulin pumps)
In addition, Medicare Part B will usually cover the drugs used for home infusion therapy, provided they are administered under the skin or with an IV over a period of at least 15 minutes. Some covered drugs include:
- Antivirals like acyclovir and foscarnet sodium for treating viruses
- Antifungals like amphotericin for treating fungal infections
- Cancer drugs like doxorubicin hydrochloride and bleomycin sulfate
- Cardiovascular drugs like dobutamine hydrochloride and milrinone lactate
- Deferoxamine mesylate for treating high levels of iron in people who have undergone blood transfusions
- Immune globulin, which are antibodies that help your body fight infections
- Pain medications like hydromorphone and morphine
Your Medicare Part B plan also typically covers the fees that the supplier charges for each visit to perform home infusion therapy.
Do Medicare Supplement Plans Cover Home Infusion Therapy?
Medicare Supplement or Medigap plans help to pay for out-of-pocket costs not covered by Medicare Part B. However, these plans generally do not cover home infusion therapy.
Do Medicare Advantage Plans Cover Home Infusion Therapy?
Medicare Advantage Plans must cover at least as much as Original Medicare. Your plan is likely to pay for the same supplies, medications and services for home infusion therapy described above. Plans may opt to cover more than Original Medicare. Normally, your Medicare Advantage Plan pays for most of the cost of covered services, and you are responsible for a copay or coinsurance.
Does Medicare Part D Cover Home Infusion Therapy?
Medicare Part D is optional prescription drug coverage available to enrollees in Original Medicare. Generally, Medicare Part B pays for the medications commonly used for home infusion therapy. If your doctor has prescribed a drug that's not covered, your Medicare Part D coverage may help to pay for the medication. You'll first have to satisfy a deductible. Depending on the stage of coverage, you will usually have to pay either a copay or 25% insurance coinsurance.
How Can I Get Help Paying for Home Infusion Therapy?
Medicaid and private health insurance may help to pay for the portion of home infusion therapy services that Medicare doesn't cover. Opting to visit a doctor's office or hospital for your infusion therapy may help lower your out-of-pocket costs. Generally, the cost of home infusion therapy is less in a long-term care facility.