Medicare coverage for home infusion services is a problem for really sick people.
Why is there no Medicare coverage for home infusion?
I was checking on this because a young woman called me and asked if I could find her a Medicare Advantage plan that would cover the home infusion services she receives. This is the second call I’ve gotten on this subject this month.
According to the Center for Medicare Advocacy:
Individuals in traditional Medicare who require intravenous or injectable medications are often stunned to learn they have to leave home to obtain this necessary care. This is true even when they are receiving other Medicare-covered home health services.
Obtaining coverage for both the medication and the professional services necessary for the infusion or injections requires billing both Medicare Parts D and B. However, Medicare Part B only pays for the administration of certain types of drugs that cannot be self-administered, and only when provided in an outpatient setting, such as a hospital, infusion center, or doctor’s office. Medicare Part D will cover the intravenous or injectable medications covered under a beneficiary’s prescription drug plan, but not the skilled services and necessary supplies required to actually administer the medication.
When beneficiaries are unable to travel to an approved outpatient setting or need to receive their infusions at home, traditional Medicare will not cover the professional services, equipment or medication. Most beneficiaries are thus forced to travel to an outpatient setting in order to receive Part B coverage for the skilled services and equipment.
The outpatient requirement under Part B effectively denies Medicare coverage for home infusions and forces medically compromised beneficiaries to leave home in order to receive intravenous or injectable medications.