Does Medicare Cover Home Infusion Therapy?
Medicare will cover home infusion therapy equipment and supplies when they are used in your home, but you will still be responsible for a portion of the cost. The equipment and supplies are considered durable medical equipment, which is covered by Medicare Part B.
- Written by Terry Turner
Senior Financial Writer and Financial Wellness Facilitator
Terry Turner has more than 35 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).Read More
- Edited ByMatt Mauney
Matt Mauney is an award-winning journalist, editor, writer and content strategist with more than 15 years of professional experience working for nationally recognized newspapers and digital brands. He has contributed content for ChicagoTribune.com, LATimes.com, The Hill and the American Cancer Society, and he was part of the Orlando Sentinel digital staff that was named a Pulitzer Prize finalist in 2017.Read More
- Reviewed ByAflak Chowdhury
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- Published: March 4, 2021
- Updated: October 13, 2023
- 5 min read time
- This page features 10 Cited Research Articles
- Edited By
|Home Infusion Therapy Coverage
|Part A (Inpatient)
|Part B (Outpatient)
|Covers 80% of medically necessary home infusion therapy costs once you have reached your Part B deductible. Copayments will still apply.
|Part C (Medicare Advantage)
|Coverage mirrors Part B. Select plans may offer additional benefits.
|Part D (Prescription Drugs)
|Most drugs used in home infusion therapy are covered under Part B, but Part D plans may pay for additional infusion drugs.
|Medigap does not cover home infusion therapy.
Medicare and Home Infusion Therapy
Original Medicare covers part of the cost of home infusion therapy. However, you still have to cover your coinsurance under Medicare Part B.
In most cases, home infusion therapy means administering a drug intravenously through a needle or catheter in your home. But it may also include administering medicines or biologics through other nonoral such as injections into your muscles or the membranes surrounding your spinal cord.
In 2022, the global market size for home infusion therapy is $45.4 billion. The home infusion therapy market is projected to be worth $65.2 billion by 2030, according to Precedence Research.
- Congestive heart failure
- Gastrointestinal diseases and disorders
- Immune deficiencies
- Infections (including sepsis, urinary tract infections and sinusitis)
- Multiple sclerosis
- Neurological disorders
- Rheumatoid arthritis
Medicare has determined that certain infusion treatments can be safely and effectively performed at people’s homes. But it points out that home infusion therapy presents challenges different to those found at health care facilities.
Home infusion therapy requires medical coordination reaching well beyond your home. It requires patients, their doctors, home infusion pharmacies and the people who plan your hospital discharge to work together to guarantee you receive appropriate care.
In some cases, home health agencies may also have to be involved in your therapy.
Medicare-Covered Infusion Therapy Costs
Medicare classifies home infusion therapy equipment and supplies as durable medical equipment (DME). This is defined as any medical equipment your doctor orders as medically necessary for use in your home.
As such, Medicare Part B covers these qualified DME costs. Medicare Part B also covers certain prescription drugs you normally wouldn’t give yourself — but those you’d receive in a hospital, doctor’s office or similar setting. This includes specific home infusion drugs.
The U.S. Centers for Medicare & Medicaid Services defines which drugs are approved for home infusion. The drugs have to be a nonoral medication or a biological administered through an IV or applied under the skin for a period of 15 minutes or longer at a time.
|Antibiotics, antifungals & antivirals
|Acyclovir, Foscarnet, Amphotericin B, and Ganciclovir only
|Flushes and dressing kits are not covered directly
|Cladribine, fluorouracil, cytarabine, bleomycin, floxuridine, doxorubicin (non-liposomal), and vincristine or vinblastine and only under strict conditions
|Only covered in specific and limited situations
|Only the drug and only if the patient has a qualifying diagnosis
|IV stands or poles
|Only if medically necessary
|Pain management medications
|Only for intractable pain due to cancer, if the patient has not responded to adequate oral or transdermal therapeutic regimen or cannot tolerate such a narcotic analgesics
|Only if medically necessary and only for listed drugs
|Only if pump criteria is met
You can check with Medicare’s database to see if specific home infusion items or services are covered.
There are several home infusion therapies Medicare does not cover.
- IV or IM antibiotics
- Catheter care (unless it is in conjunction with a covered therapy or between covered therapies)
- Injectable drugs
- Anticoagulation medications or therapies
- IV or IM erythropoiesis (such as Procrit or Epogen)
- Insulin (though diabetes supplied may be covered)
Medicare also covers 80% of the cost of services necessary to provide your home infusion therapy. This includes nursing visits, training your caregivers and any monitoring you may require.
Suppliers and infusion providers have to be doctors, hospitals, critical care hospitals, outpatient comprehensive rehabilitation facilities, home health agencies, hospices, pharmacies or other health care providers and suppliers licensed in the state where they provide the home infusion. They must also be enrolled in Medicare to be covered.
Medicare does not cover insulin pumps or self-administered drugs on Medicare’s exclusion list.
Your Out-of-Pocket Costs for Home Infusion Therapy
You are responsible for 20% of the cost of services related to your home infusion therapy. Your costs will vary depending on the type and frequency of your infusions.
Individual Medicare Supplement (Medigap) plans do not cover out-of-pocket home infusion costs. But if you have Medicaid or an employer-sponsored supplemental insurance plan, they may pick up some or all of your out-of-pocket share.
If you are facing high out-of-pocket costs, you may want to consider having the infusions done in another setting outside of your home.
You can choose infusion services through a skilled nursing facility, doctor’s office or a hospital outpatient department. The costs may be bundled into the payments the providers receive from Medicare.
Most drugs used in home infusion therapy are covered under Medicare Part B, but if you have a Medicare Part D prescription drug plan, it may pay for some infusion drugs.
Medicare Part D plans are sold through private insurers, so you should check with your plan’s administrator to determine what is covered and what your out-of-pocket costs will be.
Medicare for Home Infusion Therapy FAQs
10 Cited Research Articles
- Precedence Research. (2022). Home Infusion Therapy Market. Retrieved from https://www.precedenceresearch.com/home-infusion-therapy-market
- U.S. Centers for Medicare & Medicaid Services. (2021, February 11). Home Infusion Therapy Services. Retrieved from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Home-Infusion-Therapy/Overview
- SMART Healthcare Resources. (2020, August 28). Infusion Therapy BIG Changes Coming for 2021. Retrieved from https://www.healthcarebesmart.com/infusion-therapy-big-changes-coming-for-2021/
- Tipple, S. (2020, April 24). National Home Infusion Foundation Releases Industry-Defining Infusion Industry Trends Report. Retrieved from https://nhia.org/wp-content/uploads/2020/04/NHIA-NHIF-industry-trend-report-home-infusion-research.pdf
- Nessel, J. (2020, March 13). Congress Introduces New Legislation Designed for Medicare Patients in Need of Part B Home Infusion Medications. Retrieved from https://www.pharmacytimes.com/view/congress-introduces-new-legislation-designed-for-medicare-patients-in-need-of-part-b-home-infusion-medications
- Community Health Accreditation Partner. (2020, February 4). Home Infusion Medicare Benefit Effective January 1, 2021. Retrieved from https://chapinc.org/blog-news/home-infusion-services-medicare-benefit-effective-january-1-2021/
- Center for Medicare Advocacy. (2019, March 13). Home Infusion Therapy Services. Retrieved from https://medicareadvocacy.org/home-infusion-therapy/
- U.S. Medicare Payment Advisory Commission. (2012, June). Chapter 6: Medicare Coverage of and Payment for Home Infusion Therapy. Retrieved from https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/reports/chapter-6-medicare-coverage-of-and-payment-for-home-infusion-therapy-june-2012-report-.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Home Infusion Services. Retrieved from https://www.medicare.gov/coverage/home-infusion-therapy-services-supplies
- National Home Infusion Association. (n.d.). About Home and Specialty Infusion. Retrieved from https://nhia.org/about-infusion-therapy/
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