Ask-A-Nurse: What you don’t know about Medicare D

Posted on: January 20th, 2011 by sdavis

Becky Boley, R.N.

What you don’t know about Medicare D

After working at CarePro for nearly 20 years, R.N. and intake specialist Becky Boley has seen just about every kind of insurance policy. The latest coverage, Medicare D, promises antibiotic coverage, but she warns that it’s not all it’s cracked up to be.

What is Medicare D and what does it cover?

Medicare D is essentially a supplemental insurance plan that covers prescription drugs.

If Medicare D covers prescription drugs, will it cover my home infusion treatments?

Medicare D offers a lot of benefits to people who only need prescriptions that they can take themselves, because Medicare D will only cover the drug itself. What this means for infusion patients covered by Medicare D who want IV medications given in the home is that their insurance won’t cover the IVs or pumps used to administer the dosage or the nurse’s time to care for the patient.

If I’m on Medicare D, how much am I expected to pay for myself?

Patients who don’t have a full health insurance policy that provides coverage for home services will have to make up the difference out of their own pockets. These extra expenses will usually cost a patient around $65 per day for one medication, and that’s not even considering patients with multiple illnesses. Two antibiotics can start costing patients in excess of $100 per day. Patients can find themselves out thousands of dollars in a matter of weeks on a six week IV drug regimen.  

Am I even expected to pay for my chemotherapy out of pocket?

It is important to note that these rules don’t apply to nutrition therapies, pain management drugs or chemotherapy, which are all covered under Medicare B; however, in all cases, Medicare won’t cover nursing costs if a patient isn’t homebound. Most full insurance policies by private companies will cover all of a patient’s in-home therapy, but it’s crucial to check first before patients find themselves in over their heads.

I don’t know if my insurance plan will cover this. How can CarePro Home Infusion help me?

If a patient doesn’t know what his or her insurance will cover, the good news is we can do all the leg work to figure it out for him or her—with absolutely no obligation. In fact, since it is such a complicated process, we prefer to do it ourselves, so checking policy coverage is as easy as dialing 1-800-755-6997 or 319-363-1284 and asking for intake. And if a patient decides he or she simply can’t afford the extra cost of infusion therapy, we are more than willing to provide different options and design a plan that will help the patient without putting him or her in the red.

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