Q & A
Will Medicare pay for infusion therapy?
Full Question: My husband was recently in the hospital for a pacemaker implant. He was set to come home but developed a staph infection and a blood clot. He now has to receive an antibiotic infusion for six to eight weeks.Medicare would not pay for home infusion, so he has to travel 30 minutes to the infusion center every day. Is there anything we can do?
Answer: Probably not. Infusion therapy means administering drugs intravenously, and although it can be done in settings such as outpatient centers, hospitals or nursing homes, many patients would prefer to receive their drugs at home. But even though most private health plans and some Medicare Advantage managed care plans pay for home infusion, the traditional Medicare fee-for-service program generally does not.
There’s an exception for roughly 30 drugs that must be administered using an IV infusion pump. These are covered under Medicare Part B’s durable medical equipment benefit. But Medicare generally won’t pick up the tab to intravenously administer other drugs such as antibiotics at home, even though the drugs themselves may be covered under Part D, Medicare’s prescription drug benefit. “It’s a basic flaw,” says Russ Bodoff, president and CEO of the National Home Infusion Association, a trade group for home infusion providers. “Every site of care is covered except the home.”
Bodoff’s organization is working on legislation that would expand Medicare’s coverage of home infusion therapy. For now, though, if you want your husband to receive his antibiotic IV therapy at home, you may have to pay for the cost of the equipment, supplies and any nursing services on your own.
Source: Michelle Andrews, Seattle/LocalHealthGuide - 8/12/2014
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