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Thread: Medicare- Is there ANY way to get HOME IVs covered?

  1. #1
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    Unhappy Medicare- Is there ANY way to get HOME IVs covered?

    Hello! I had an account here years ago but could not remember my user name so I re-signed up. I'm 34 with cf and have been on SSDI for 2 years now. I'm eligible for Medicare Sept 1st. Unfortunately I'm sick right now and will probably end up in the hospital and on IVs. I called my home infusion company and they said it's dicey to get iv antibiotics covered. Awesome! I'm in Texas currently (we're thinking of moving to CO) and I have ONE supplemental plan option. Not that it would help cover the costs of the ivs because it wouldn't. It's also VERY expensive. $367 a month. Aetna. Plus I will start having $109 deducted from my SSDI for Traditional Medicare (Part A & B). Plus I have to purchase a prescription plan (part D) that looks like it will cost $70-99. I have called Compass, talked to two local medicare reps and NO ONE knows a good PDP plan that's affordable. Compass actually sent me the WRONG info and was very insulting to me about the fact that I was anticipating a hospital visit. Ariel said, "You can't anticipate a hospital visit, most cfers are on Kalydeco or Orkambi and have 90% lung function and don't go to the hospital much." UMMMMMM she needs some training on CF and sensitivity. I have a nonsense mutation and am not eligible for any of that! You still have a huge copay to pay before the max amount is met. Medicare is looking less attractive than my horrible ACA independent plan. I don't want a managed care plan because they are basically HMOs and limit your Dr's. I already haven't been able to see my Endo, ENT, GI, and liver Dr. bc of my current HMO plan. So I'm thinking I'll have to stay on straight Medicare and be responsible for the 20% in the hospital. Make payment plans. We just simply cannot afford the supplemental AND everything else. I've also been told my out of pocket prescription costs are going to be high even with a part D plan. Just freaking fabulous! So........that was long winded but..does anyone know of a Medicare prescription plan that has decent copays for home iv infusions? I can't really go to an infusion center bc I'm on continuous 24-7 zosyn. I am usually on it for 3 weeks now. I cannot spend that much time in the hospital....I have a 2 year old son at home. I realize I am going to have to pay for the supplies out of pocket. Like flushes, needles, and gloves. I work for a DME company part time in billing (how I have some medicare knowledge) and I can get the supplies from them. Just not the iv antibiotics. My Dr. usually admits me to the hospital for a few days and then I go home on IVs for the remainder.

  2. #2
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    I'm so sorry for the crappy situation you're in! We did have a member here who figured out how to get home IVs through original Medicare but I haven't seen her around for awhile. Pretty sure her name is Jen and screen name "justducky". I'll try to search for an old thread and see how she said she did it.

    I thinks it's crazy that Medicare doesn't cover home IVs. It would save them tons of money. I do think they cover the home nursing visits, but not the actual meds. Grrr... Anyway, let me see what I can find!

  3. #3
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    Here it is! Unfortunately I'm not sure if Jenn is still with us. Maybe someone else on here knows Jenn?

    http://forums.cysticfibrosis.com/showthread.php/17356-MediCARE-participants-who-receive-home-infusion-services?highlight=Medicare%20home

  4. #4
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    You might want to call the cff.org free legal service as they'd know the ins and outs.

  5. #5
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    I am 77 and my experience in dealing with Medicare is if you need 14 days of IV's, you spend 14 days in the hospital. I would also suggest that you purchase the best Medicare Supplement plan that you can find.
    Male 77 CF undetected until age 47. (First symptoms at age 3) Delta F508 & V562I with one copy of Variant 5T. 100% PI. MAC, CFRD.

  6. #6
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    After retiring and going on Medicare, I was quite surprised that home IV was not covered.

    They did cover the cost of the antibiotics, the blood testing, and the home nursing. It was the "dispensing "pump" that was not covered.

    It ended up costing me about $35 per day. I found this more desirable than going into the hospital or to an infusion center.
    Last edited by stephen; 08-28-2017 at 04:14 PM.
    75 Y/O with CF (D1152H and G542X) and Broncheiectesis.
    FEV1 Low 40s%.
    On Kalydeco since March 2014 and doing great.

  7. #7
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    Thanks!! Ughh that is so sad.😢 I saw her post and while it sounded like a good deal, I know my Dr would never go with it.

  8. #8
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    Yikes! $35 for a pump is still pretty expensive. I appreciate the response though.

  9. #9
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    I'm not eligible for many supplemental plans bc I am under 65. The only one I'm eligible for is $360 a month...add in straight medicare and PPD plan. Nit affordable.

  10. #10
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    I called Compass (cf legal hotline) in June and they have not been able to help me prior to today. I finally got someone...named Aaron who is helping me nail down a Medi care Advantage plan that seems to be good and may allow me to get home ivs w a $100 copay. I'm calling tomorrow to verify. I'll let you all know if it works! It's called Care Improvement Plus RPPO. I believe only $36 a month on top of my $109 A & B. Replaces the part D prescription plan.

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