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

atrippet

New member
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.
 

triples15

Super Moderator
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!
 

triples15

Super Moderator
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
 

Printer

Active member
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.
 

stephen

Super Moderator
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.
 
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atrippet

New member
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.
 

atrippet

New member
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.
 

atrippet

New member
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.
 

benthyr123

New member
Home IV therapy

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.
I'm really curious about this. I have always bitched to my doctor that 2 weeks in the hospital is putting me at more risk than home treatment. Since entering Medicare...I've had to stick it out in the hospital with triple the costs...that's government policy for you! My medicare supplement will not pay on any service that medicare denies, so I'm stuck. I didn't realize there was any Medicare Advantage program out there that we could qualify for if considered disabled. I really hope this is the answer you are looking for because it will be my answer too.

52yo female, DDF508, FEV1 49%, Orkambi since 9/16
 

rtorres25

Member
Hi,
I hope you get your home IV's and supplies covered. I always end up with leftover supplies, like boxes of saline and heparin flushes, iv change kits, etc. I wish there was some way to get them to folks who are paying out of pocket for these things. I can't even find anywhere to donate them. They are all still sealed and sanitary. I usually hang on to them in case I need them again bf they are expired, but most of the time I end up throwing them away. :(
 

Tamika CF nurse

New member
Hi there,

I am so sorry that you are having to deal with these issues while you are sick. Unfortunately as nurse coordinator I have encountered similar situations.

We have had to use the help of a nonprofit organization called Cystic Dreams in the past to help patients get things paid for that insurance didn't cover and or were too expensive.*

https://www.cysticdreamsfund.com/

On the last post it sounded like maybe compass at cff.org was able to recommend a more affordable plan for you? Did you get the help you needed from Compass? They can be very helpful as they have tons of resources. *

Each situation, state, region and plan is so different.*

If you think its appropriate I'd be glad to speak with you and try to figure it out together.*
 

LunaFaith

New member
I know every state is different so I don't know if this will help but I am assuming you are on disability to be eligible for Medicare at 34, if that is the case you may be eligible for SSI, Here in NC I am on both SSDI and SSI, being on SSI qualified me for Medicaid which helps, though home infusion is still an issue for me, my hospital UNC has a care program that helps cover the few things my insurance won't. I am also confused about the Medicare part D supplement plan, my dad who is 56 and on disability has a supplement plan, mine was set up for me when I got my disability so I've never had to look for my own supplement plan
 

atrippet

New member
Thank you everyone! Just saw these posts. I've had a sick fall with back to back hospital stays. Home ivs ended up costing me $200 for one week. I could not opt out of supplies even though I already had that stuff. The infusion company said I had to pay for all. At least it got me home. I did not qualify for Medicaid or any financial assistance. Even though my husband and I both have cf and are on disability. We put too many work credits into the system. Good for us at the time to work as long as we could so whatever. Thank you Tamika..I will be looking into that. My medicines are extremely expensive right now bc I'm in the "donut hole." I don't understand how they expect me to pay $900 for one medication... $128 for another... $100 for another..it's crazy. Most of the copay assistant plans I can't use bc of Medicare. I did find 3 Medicare ppl can use:

1) got to keep Healthwell
2) PAN Patient Assistance Network
3) PSI Patient Services Inc.

This Medicare advantage plan is good in the fact that I can see whatever Dr I want and travel over state lines. In Network benefits are the same as Out of Network. So I have seen some of my specialists that I haven't been able to see.

Another way to get ivs covered is to go to an infusion clinic. Covered under part b but still costs a lot. I don't know how much bc I didn't do that bc I would have had to wear a pump...and go into the office 3 times a week..not close to my house. I'm on continuous zosyn. The home infusion company I went with had gravity ball.

All and all...I think it is the best option. It kept me out of the hospital some of the 5 weeks I was on ivs.

In Jan I will be able to apply for tier exemptions that will make my scripts cheaper.
 

Doglover

New member
Can you please give me the name of your supplement plan and the cost. We have been going through enrolling in medicare and the drug costs are unaffordable on top of what a supplement costs.
Just creon, Humalog and one other are 500.00 a month.
Also what state are you in?
 
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