Medicare to start covering home infusions

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    • #117748
      SandraP
      Participant

      Beginning January 1, 2021, Medicare Part B will cover 80% of the cost of nursing care for home infusions of IVIG for Medicare enrollees. If you have received your new Medicare and You booklet, you’ll find a mention of this on page 42. A very long, detailed explanation of the new benefit is on the CMS website. I have confirmed with Optum, my home infusion service, that their billing department is scheduled to receive training soon on how to bill for this benefit and will start billing Medicare on January 1. This will save me thousands of dollars every year. The IVIG drug is covered separately by Medicare Part D, and I’ve been getting that benefit all along (paying 20% co-pay), but I’ve been paying for nursing services at home in full out of pocket. Medicare did a years-long demonstration project and concluded that home infusions have health benefits for patients that justify the coverage.

    • #117749
      SandraP
      Participant

      Here’s the CMS.gov page that explains the home infusion benefit: https://www.cms.gov/files/document/mm11880.pdf

      • #117924
        Ron
        Participant

        What Part D insurance do you have?

    • #117806
      David Portinga
      Participant

      Are you sure that home infusions for CIDP are covered? The company that I use doesn’t think so.

    • #117813
      SandraP
      Participant

      Yes. It applies to all home infusions. The GBS/CIDP Foundation was instrumental in getting this change in effect. I use Optum, and they are currently training their billing department in dealing with Medicare. If your infusion company won’t work with Medicare, you need to go elsewhere.

    • #117925
      SandraP
      Participant

      This change to Medicare was due to take place in January 2021, but I was told that because coronavirus consumed all the attention it failed to get scheduled for a vote in Congress. (sigh) There is some hope it might be passed this year to take effect next year, but we’ll have to wait and see. I was very disappointed to learn it hadn’t happened after all. Some types of home infusion are already covered by Medicare, but not for CIDP — not yet. I’m sorry if my post caused confusion. I posted what I was told at the time.

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