Thank you! I have been looking at gap policies, and the medicare website says they all MUST cover the same. It seems pretty clear that medicare covers ivig for CIDP,The question is, if it is covered under part B or part D. If it is under part D there are all kinds of extra charges and there is no gap policy I can find that will cover it. It would be expected to pay about $1700 per month: basically the donut hole thing and then after coming out of the donut hole, I would pay 5% of the price of the drug, which would be about 1300, then add in the cost of all the plans (medicare A &B and Medigap and Part D insurance of about 400 per month, then add in the extra cost of my other drugs and it gets way higher. Crazy for folks with chronic conditions. I have several, as do many folks with CIDP because one autoimmune disorder usually means more than one. I have three: CIDP, MS, MGUS and then there is trigeminal neuralgia and cancer.
juliebug1947 said:
kristypsmick said:
Be very careful when researching this issue. I am on medicare and I am receiving ivy I g infusion monthly.. Coverage for this service is under park B. If you do not have a gap policy you will be billed the exccess charge. This is not a coverage on your prescription plan. It is definitely a part b service. Read your policy you buy very carefully. Better yet, call the insurance company that is representing you for your gap policy and make sure that they tell you that you have no cost sharing, no deductible, or no copay. Be aware they are three completely different things. This was the snag when I purchased my policy. The sales department for the medicare policy i bought in michigan told me there was no deductible. This was when I told him to make sure I had no out of pocket expense at all. again, it is very important that you understand that IVIG infusion are covered under Medicare Part B. You must, I repeat must buy a gap policy. A gap policy that will cover any excess charge be it deductable coinsurance or co pay. When you purchase your gap policy make sure all three of those words are indicated for coverage to exist. Take it from someone who has been caught in the loop and has been going through an appeal process on this very issue for the last 7 months. I am currently being billed nearly $700 a month while this is an appeal
Medicate only covers infusions in an outpatient setting
I tried the argument that itbis medication covered under d
No. CIDP is the only autoimmune disease that is covered for these infusions, but it is definitely Part B and you WILL need to find a Medigap policy to cover the 20%. There are resources out there to help with infusion costs, but alot of special criteria. Seems as though coverage for these infusions are in a doughnut hole of their own. Good luck. Once you are off private insurance and on Medicare, coverage is nearly nonexistent. Make a sales agent that says ivig infusions are covered put it in writing. I researched 6 months for Michigan companies and as you can see my supposed success came back empty handed and on appeal.
Medicare will not pay for my IVIG, they did when I received it in the hospital. My supplement will pay but I would have a $5,000 co pay.
Are you referring to Medicare Part A or Medicare Part B? Again infusions are covered in an outpatient setting under Part B. Infusions are not covered in the home. If you received infusions while in a hospital stay, yes they are covered. If you receive them as an outpatient is covered under Part B but you will still need a gap policy for the 20%
Medicare won't pay for them at all, not as an outpatient or at home. Supposedly it is because of my kidney function but it is no worse than it was when I had the treatments in the hospital/
I was represented in Michigan on the coverage issue by the Michigan Area On Aging that assists individuals on Medicaid and Medicare with issues dealing with insurance and coverage. They learned alot through my appeal. If you say Medicare did or didn’t cover your infusions then you need to follow it up by also saying that it was covered while you were in a hospital stay which would be Part A, or that it was covered by Medicare under Part B as outpatient which covers only 80%. Medicare is a federal insurance coverage, the same everywhere. Please be careful not to confuse others when responding by not saying specifically Part A or Part B. There is a huge difference. Good advice for all of us replying about Medicare.
I have Medicare I am covered at home I am not sure how as I do have a sublime yak from my carpenters union.