Does Medicare Cover Home Infusion Therapy?

Home infusion therapy offers a way for patients to receive necessary intravenous or subcutaneous medications in the comfort of their own homes. This method of care can be beneficial for individuals requiring long-term treatment, those with mobility challenges, or anyone seeking to avoid frequent visits to a clinical setting. Medicare provides coverage for home infusion therapy. This coverage helps beneficiaries access a broad range of services and supplies needed to manage their conditions at home.

Medicare Coverage for Home Infusion Therapy

Medicare generally covers home infusion therapy under different parts, with specific components falling under Part B, Part D, and in some cases, Part A. The primary framework for home infusion therapy services falls under Medicare Part B. This includes the administration services, nursing care, patient training, and monitoring associated with certain infused drugs.

Medicare Part B also covers durable medical equipment (DME), such as infusion pumps, and related supplies like tubing and catheters, necessary for administering these medications at home. Infusion drugs themselves, if they require administration through a Part B-covered external infusion pump, are typically covered under the Part B DME benefit. For self-administered drugs not covered under Part B, Medicare Part D may cover the cost of the home infusion medications. However, Part D does not cover the associated equipment, supplies, or nursing services.

Medicare Advantage Plans (Part C) are private health plans that contract with Medicare to provide all Original Medicare benefits. These plans must cover at least what Original Medicare covers, including home infusion therapy. While Part C plans offer equivalent coverage, they may have different cost-sharing structures, such as copayments or different deductibles, and might require using in-network providers. Medicare Part A, which primarily covers inpatient hospital care, may cover home health services, including some nursing services related to home infusion, if a patient meets specific homebound criteria. However, home infusion therapy services are generally excluded from coverage under the Medicare Home Health benefit, as mandated by the 21st Century Cures Act, shifting professional services to the Part B home infusion therapy benefit.

Defining Covered Home Infusion Services

Medicare’s coverage for home infusion therapy encompasses a range of services and supplies essential for safe and effective treatment in the home environment. These include:
Infusion drugs that require administration via an external infusion pump covered under the Part B Durable Medical Equipment (DME) benefit. This specific coverage applies to a defined list of drugs that meet these criteria.
Necessary supplies such as the infusion pump itself, IV poles, tubing, and catheters, all considered durable medical equipment.
Professional pharmacy services, which typically involve the preparation and delivery of the drugs, as well as patient education related to their medications.
Skilled nursing services for the administration of the therapy, patient training, and ongoing monitoring. This nursing care ensures the safe provision of the therapy, proper management of the infusion site, and education for the patient or caregiver.
Remote monitoring and other monitoring services, allowing healthcare providers to assess treatment response and address any complications.

Patient Eligibility for Coverage

For Medicare to cover home infusion therapy, patients must satisfy specific criteria. A physician must determine that the home infusion therapy is medically necessary for the patient’s condition. This determination requires a physician’s order and a comprehensive plan of care that details the type, amount, and duration of the infusion therapy services.

The therapy must be administered by a Medicare-certified home infusion provider. These providers must be accredited by a Medicare-approved accreditation organization and are required to enroll in Medicare as a Part B supplier, specifically under specialty code D6. This ensures that the provider meets federal health and safety standards for delivering home infusion services. The patient must be under the care of an applicable provider, such as a physician, nurse practitioner, or physician assistant.

While homebound status was previously a requirement for certain home health services that included infusion, it is generally not a requirement for the new Medicare Part B home infusion therapy benefit itself. However, if a patient is also receiving other home health services, they may still need to meet homebound criteria for those distinct services. The home infusion therapy supplier must be able to provide services seven days a week, 24 hours a day, ensuring continuous and safe provision of care.

Patient Costs for Home Infusion Therapy

Patients receiving home infusion therapy under Original Medicare (Part A and Part B) typically incur out-of-pocket costs. For services covered under Medicare Part B, such as the infusion drugs (if administered via a Part B-covered pump), durable medical equipment, supplies, and professional services, patients are responsible for the Part B deductible. In 2025, the Part B deductible is $257.

After the deductible is met, Medicare Part B generally pays 80% of the Medicare-approved amount, leaving the patient responsible for the remaining 20% coinsurance. This 20% coinsurance applies to the covered drugs, supplies, and professional services. If a home infusion drug is covered under Medicare Part D, beneficiaries typically pay a deductible, copayment, or coinsurance, which can vary depending on their specific Part D plan and its formulary.

Medicare Advantage Plans (Part C) must cover at least the same services as Original Medicare, but they often have different cost-sharing structures. Patients in Part C plans may have copayments or different deductibles for home infusion therapy, which can vary significantly between plans. Medigap (Medicare Supplement Insurance) policies can help cover some of the out-of-pocket expenses, such as the Part B coinsurance, that Original Medicare does not pay. However, the extent of Medigap coverage for home infusion therapy varies by policy type.

Accessing Home Infusion Therapy Through Medicare

Initiating home infusion therapy with Medicare coverage involves a structured process. The first step is obtaining a prescription and referral from a physician. The physician must establish a comprehensive plan of care, outlining the specific therapy, dosage, frequency, and duration, which serves as the foundation for all services.

Choosing a Medicare-certified home infusion provider is a crucial subsequent step. Patients or their caregivers should verify the provider’s Medicare certification and participation status to ensure coverage.

Prior authorization may be required for certain home infusion services or specific drugs, depending on the Medicare plan. It is important for the patient or provider to confirm any prior authorization requirements with Medicare or the Medicare Advantage plan before services begin. Effective coordination of care among the physician, the home infusion pharmacy, and nursing services is essential throughout the therapy. This collaboration ensures seamless delivery of medications, supplies, and professional support, including patient education and monitoring, in the home setting.