Intravenous immunoglobin (IVIG) is a solution containing antibodies that healthcare professionals may use to treat primary immune deficiency disease (PIDD) and various other conditions.
The amount Medicare pays for IVIG can vary based on certain factors. These include the condition it is treating, a person’s specific Medicare plan, and whether they receive the treatment in an inpatient or outpatient setting.
The different parts of Medicare may cover IVIG differently.
If a person with Original Medicare receives a diagnosis of PIDD, Part B (medical insurance) can cover at-home IVIG treatment. The coverage may include the medication, equipment, and services related to its administration.
However, a person has to meet certain criteria for Part B coverage:
- They must have a diagnosis of PIDD.
- The IVIG must be an approved pooled plasma derivative for treating PIDD.
- A healthcare professional must provide the IVIG in a person’s home.
- Their doctor must consider at-home IVIG a medically appropriate treatment.
Part B may also cover the cost of IVIG administered in a hospital outpatient department or clinic. However, Medicare Part A can cover the cost of IVIG administered during an inpatient hospital stay.
Medicare Part D primarily covers prescription drugs. However, depending on the treatment’s classification, it may also cover IVIG treatment.
In some cases, certain components of IVIG therapy might fall under Part D coverage. Medicare-approved private insurance companies issue Part D plans. These plans may include coverage for the supplies and medications necessary for administering IVIG at home.
However, the costs depend on the plan’s formulary and specific coverage rules. It is a good idea for a person to check with their Part D plan provider for specific details related to their IVIG treatment.
As with Part D plans, private insurance companies offer Medicare Advantage plans. These plans offer the same coverage as Original Medicare and typically include prescription drug coverage.
The cost specifics and coverage level can depend on the plan specifics, the insurer, and a person’s location. It is a good idea to review policy details for accurate information.