At Coram, we’re here to help Medicare beneficiaries, like you, navigate your benefits. Your Coram team of reimbursement and insurance specialists will review your benefits. They’ll let you know what’s covered and what you can expect to pay.
Medicare coverage can change from year to year. So, ask your Coram team for the latest details. We’ve also broken down some facts to help you learn the different parts and coverage for home infusion care.
About Medicare
Medicare is health insurance program provided by the U.S. government. It’s offered to eligible people who are:
- 65 years old or older
- 65 years old or younger with certain disabilities
- Of all ages with permanent kidney failure requiring dialysis or a kidney transplant
Medicare A-B-C-Ds
Medicare has four parts – A, B, C and D. Each part – or program – helps cover different medical care, products and services. Each part may vary by how much it costs each month to be enrolled. This is called a premium.
Part A is hospital insurance – No premium
- Medicare-eligible persons are automatically enrolled
- Helps cover inpatient and critical access (designated rural) hospitals, skilled nursing facilities (not custodial or long-term care), hospice and some home health care
- People must meet certain coverage conditions
Part B is optional medical insurance – Monthly premium
- Helps cover doctors’ services, outpatient care, select medical services that Part A doesn't cover and some home health care
- Helps pay for these covered services and supplies when they’re medically necessary
Part C is the optional, Medicare Advantage program – Monthly premium
- Provided by private insurance companies contracted with Medicare
- Covers all that Part A and Part B covers, but with extra benefits
Part D is optional prescription drug coverage – Monthly premium
- Available to all Medicare beneficiaries
- People must join a Medicare-approved plan with Part D drug coverage
Home infusion and tube feeding coverage
Remember, we’re here to make sense of your Medicare benefits for home tube feeding or home infusion therapy. They vary by part, your therapy and other factors. We’ll also help coordinate care based on your benefits and find resources if something isn’t covered. Here are the basics:
Part A
- Home tube feeding – Not covered
- Home infusion – Not covered
Part B
- Home tube feeding – Covered based on the medical need and when the therapy is given at home for 90 days or more. It helps cover items like formula, administration sets and supplies, feeding tubes, pump rental or purchase, and an intravenous (IV) pole. Both formula and supplies must come from one supplier for coverage.
- Home infusion – Partly covers certain therapies and conditions that use durable medical equipment based on the medical need and certain health criteria. Parental and enteral nutrition may have coverage if therapy is for 90 days or more and other criteria is met. Primary immune deficiency patients may get coverage for IV immunoglobulin but not supplies and equipment.
Part C
- Same coverage as Parts A and B
- For other benefits, ask your Coram team or Medicare Advantage plan
Part D
- Home tube feeding – Not covered
- Home infusion – Possible coverage for infusion medications. But clinical services, supplies, equipment and nursing aren’t covered under Part D
We know this is a lot to take in. Learn more about infusion-care benefits at the official U.S. Government site for Medicare. Visit Medicare.gov. Or to ask your Coram team questions, call us.
This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about your medical condition and prior to starting any new treatment. Coram assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result.
Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.