Medicare coverage of home infusions advice needed

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Ohiostate

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Joined
Jun 8, 2021
Messages
3
Reason
DX UMND/PLS
Diagnosis
12/2019
Country
US
State
OH
City
Findlay
Medicare advice needed. I am 64 and my wonderful wife who is a nurse gives my Radicava infusions at our home in Ohio. My work insurance covers the home infusions. I soon have to sign up for Medicare as my work insurance stops when I am 65. Does anyone have advice on having Medicare cover home infusions. I understand it would need to be covered under Part D as a drug but it takes special approval which includes a formulary exception from the doctor. An advantage or supplemental plan is also needed. I understand approval is not guaranteed. We were thinking about going with Part G versus an advantage plan.

Just want to see what coverage others have gotten to have home infusions and Radicava paid for. Which Medicare providers cover it under D (Anthem, Humana?..)? Do you need a supplemental or advantage plan and could you suggest a provider who is known to cover home infusions? Any help and info would be appreciated!
 

blitzc

Distinguished member
Joined
Apr 20, 2018
Messages
453
Reason
PALS
Diagnosis
01/2018
Country
US
State
OH
City
Massillon
Welcome, Ohiostate! As a fellow Buckeye I have also had home infusions for 3 1/2 years first with private insurance and assistance from Searchlight, a third party foundation for pricey medications. I switched to Medicare coverage when my SSDI was approved almost 2 years ago. At that time I purchased Medicare Advantage insurance from Aetna. My nuerologist mentioned that it was friendly toward Radicava coverage. I did need to use a different foundation for financial assistance-Health Wellness Foundation. This was reccommened to me by my infusion pharmacy, Soleo. So with this foundation, Medicare, and Aetna, Soleo has been able to maintain home infusions with my husband as the "nurse" and a nurse to access my port and change the needle. My out of pocket expenses have been about $1300 for the year. (I think)

Good luck!
 

Ohiostate

New member
Joined
Jun 8, 2021
Messages
3
Reason
DX UMND/PLS
Diagnosis
12/2019
Country
US
State
OH
City
Findlay
Was it a PPO Aetna plan?
 
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