Medicare and IVIG

General General CIDP Discussion
1

I currently have private insurance through my wife's employer. I am considering switching to Medicare part B (I already have part A), to help save money. Our private insurance is costing us so much money each month that I need to find a better option. I am eligible for Part B Medicare coverage but I am concerned about Medicare, if it covers IVIG treatments and what does it cost? Are there Copays? How much are the Copays?

I cannot afford to switch if they do not cover it 100% through Medicare or a Supplementary plan. Obviously I cannot afford to pay 20% of $8000 every two weeks which is how often I receive my infusions. I have called Medicare as well as several private insurance companies for more information but I am not getting consistent answers to my questions. CIDP is rare enough that nobody I have spoken to on this subject can give me a definitive answer, does Medicare cover the cost of IVIG? I have heard about something called the Coverage Gap where after a certain amount is paid for prescriptions the coverage has a gap. This gap means that after Medicare has paid out $3,300 in a calendar year for prescriptions the coverage drops to where the patient has to pay more than 50% of their medications until they reach what is called Catastrophic coverage. After reaching the Catastrophic level they begin to pick up a larger portion of the cost.

Currently my infusions are covered 100% with no copays.

Does anybody with CIDP that receives IVIG infusions have any knowledge on this subject?

How much does it cost per treatment through Medicare? Who do you use? What does it cost?

Is there a special program to help pay the costs of this needed but expensive drug?

The IVIG treatments work well for me, they keep me breathing and above-ground. For that I am thankful but the cost of this treatment is crazy expensive.

Any suggestions from anyone would be greatly appreciative. I am currently on SSDI and I receive a Disability Pension from my last Employer.

Thank you for your help,

Dave

2

I'm on disability and will be receiving my IVIG treatments thru Medicare. The home health agency called last week to say they received the paperwork from the doctor and will be letting me know how much I will be responsible for in a week or two. I'm newly diagnosed with CIDP (I had GBS in 2009) so I've never had a infusion outside the hospital and I receive Medicare part B. Once they tell me I'll let you know but ......... it will be a couple of weeks

3

Hi Dave,

I have my IVig treatments covered by Medicare and my supplementary Anthem Blue Cross/Blue Shield insurance companies combined. I pay nothing for my infusions. Medicare will not fight it. It's your supplementary insurance that will balk because Medicare doesn't pay that much of the total, leaving the supplemental with the balance. I'm 65 and have regular Medicare, not disability Medicare. I don't know if that makes a difference or not. The supplemental is not that expensive. I think it's $200 a month. Medicare costs me $104 a month because I get very little from my social security.

Some places bill the IVIG under part D, the prescription part of medicare, or if you use your supplemental for part D. Mine bills under Part B. But, I have heard they sometimes bill under part D. Just make sure you are covered before you change anything.

Good luck.

Jan

4

Thanks for the information, it seems that it is covered under part B because my infusions are inside a clinical environment. I have my Farmers Insurance agent pricing me out different options, Blue Cross seems to be the best option so far. I would still like to hear from other who are in the same situation.

5

I heard from the home health agency and Medicare will pay for IVIG. The full amount and the part B is paying for it. I have Aetna. However they are not paying for the nursing cost or the supplies. I guess it's b.y.o.b. (bring your own band aids :) and nurse. However I qualified for a program and I'm 75% sure she said it was a Medicare one that waived those cost because I'm on disability and my income was under a certain amount. I'll know more when they send out the paperwork which they said would be soon so....... probably in a couple of weeks. I hope!

6

I get the infusions every two weeks, I need it to be 100% covered. Looks like it will be according to my insurance agent and the people at BCBS told him. Thanks for your thoughts and good luck with yours.

7

Spelcheker,

I'm on Medicare, and it's complicated, but here goes.

Medicare Part B covers only doctor's visits and a few other things, and that is paid at 80% of Medicare approved rates. You would be responsible for the other 20%, unless you have a Medicare supplement. Be careful of "Medicare Advantage" plans, because they are like HMO's and control much more of your healthcare than plain Medicare.

For best supplement coverage, try getting a "Part F" supplement. You can read more about that on Medicare.gov.

Medicare may cover IVIG for CIDP patients but only when it is done at a hospital or infusion center using Part B (and a supplement if you buy one..highly recommended you do buy one).

Most important is this: If you don't sign-up for Medicare when you are first eligible, (you have six months from first date of eligibility, it doesn't have to be in open enrollment unless you blow through the six months without signing-up), you will be penalized 10% of the cost of your Medicare premium every year after that. That isn't a one time charge, it's a rolling 10%, which means every time Medicare premiums go up, you have to pay 10% of the higher premium...so SIGN UP WHILE YOU CAN OR UNCLE SAM WILL COME FOR HIS SHARE WHEN YOU DO SIGN UP!

If you want prescription coverage, you need to sign up for Medicare Part D. It is separate enrollment from Parts A&B, and can be through any of hundreds of insurance companies. I like Silverscript, but that is just me. You can go to Medicare.gov and use their "choose a Part D provider" tool. Enter all of your medications including IVIg, and that way you will see which company offers you the best coverage and best premium.

If you still have time in your six month window, I'd go to Medicare.gov and download "Medicare and You 2016" and read it twice! It is filled with very important facts you need to know.

Finally, if you want home infusions of IVIG with CIDP on Medicare, there are a very few home health providers out there which offer financial assistance programs (they are usually really liberal with the earned amounts to qualify for financial assistance) and it's billed through Part D prescription coverage, only. Medicare in general does not cover home health care for CIDP patients, but if you qualify for the financial assistance through an IVIG home health company, they will usually absorb the costs above and beyond the cost of the medicine.

My hands are all cramped-up, so I have to stop here. I hope this helps you. It's complicated but I read your question a few days ago, before I became a member, and I needed to say something before you made a decision.

I hope everything works out.

8

Dave,

If you're still concerned about having 100% coverage, talk to the billing department of your neurologist's office, or hospital. They are worth their weight in gold! If your neurologist has been working with CIDP patients, he or she should have a good billing department who can find out answers to your questions. As I told you, I have Anthem Blue Cross/Blue Shield as my supplemental to Medicare and have not paid a penny. I see the EOBs come through. They start with about $13,000 for each infusion and work it all out. Having Medicare and a supplemental is a good thing as long as they know how to bill them.

JanD

9

Thanks for everyone's help, the Neurologist I use has it's own infusion center. I have picked a Premium Supplement plan to go with the part B, I should be good to go. The supplement is administered by my current insurance carrier and the infusions will be covered.

Dave

10

That's great to hear!

Hoping that you get a lot of benefit from your IVIG therapy.

Not to sound like a broken record (or is it DVD these days?) but you will definitely want to sign up for Part D, so you can take advantage of prescription coverage.

Happy New Year!

11

Dave,

Ask your insurance guy how to do your prescriptions. I was told by my supplemental insurance NOT to sign up for part D with Medicare. They work it out with Medicare. Every policy is different! Just make sure you have prescriptions. But, ask your insurance guy what to do.

JanD

12

I am also starting up shortly on Medicare and on home infusion for IVIG for CIDP. I’m also very confused because I hear sometimes that the drug (Gammagard) is covered under Part B and sometimes under Part D. I’m fine going out to an infusion center, if that is what I need to do to be covered. My neurologist and the company doing my home infusions all say they can’t help me with understanding how their other Medicare patients pay ‘due to HIPPA regulations’. I know Medicare is state-specific. Does anyone in IL currently have their treatment covered by Medicare? (Unfortunately Anthem BCBS isn’t available in IL).
Thanks!

13

Hi Linda, I think this is a great question. I’m going to reply to your post to see if anyone can help.

Does anyone in IL have their treatment covered by Medicare?