IV infusions and Medicare: Coverage details

Medical News Today

5 days ago

Original Medicare provides coverage for IV infusion therapy when a doctor determines it to be medically necessary, both in a clinic setting and at home.
Medicare Advantage (Part C) plans need to offer the same services as Original Medicare, though a person's out-of-pocket costs will differ and will depend on their plan.
This article discusses coverage options for IV infusions through Medicare. When does Medicare pay for IV infusions?
Medicare Part A, Part B, and Medicare Advantage (Part C) plans generally all cover IV infusions if these are medically necessary.
However, whether Medicare deems a person's IV infusion medically necessary depends on each case. That said, examples of medications or other liquids that healthcare professionals administer via an IV include :
chemotherapy drugs
Immunotherapy drugs
targeted therapy drugs
anti-nausea medicines
hydration fluids
antibiotics
Any IV infusion must last at least 15 minutes to qualify under Medicare. In addition, Medicare will cover hydration therapy when medically necessary with an IV infusion, which is considered part of the same treatment as long as the hydration therapy lasts 20 to 30 minutes or less. Does Medicare cover IV infusion at home?
Medicare Part B covers the equipment for home IV infusion under its durable medical equipment (DME) benefit.
In addition, Part B will cover the infusion drugs themselves and support the infusion through nursing visits, caregiver training, and patient monitoring. Are infusions covered by Medicare Part D?
Medicare Part D covers drugs that a person can administer themselves. Because individuals cannot administer their infusion, their IV infusion will fall under the coverage of Part B. How much does an IV infusion cost?
Original Medicare comprises parts A and B. Part A covers hospitalization and general Medicare care. A person receiving an IV infusion during their hospital stay must meet a 2025 deductible of $1,676 before coverage begins. In most cases, people do not pay a premium for Part A.
A person receiving infusion therapy under Part B must pay a premium that starts at $185, depending on their income, and meet a deductible of $257. After that, Part B pays for 80% of infusion costs.
A person enrolled in a Part D plan will get the same coverage as under Part A and Part B. However, private insurers manage these plans, which have different premiums, deductibles, and coinsurances.
According to the Centers for Medicare & Medicaid Services (CMS), the average monthly premium for Part C plans is around $17 in 2025. How much does home infusion therapy cost?
How much IV infusion, whether at home or in a medical setting, might cost out of pocket before and after insurance depends on the type someone needs and the duration of the treatment.
One 2023 review estimated the cost per day for home infusion to be $122 and for inpatient infusion to be $798.
This review also examined six studies, finding that home infusion therapy could save significantly more money than inpatient infusion. One study reported savings of over $40,000 per patient, while another projected nearly $3 billion in savings for Medicare over 5 years.
Medicare parts A, B, and C (Medicare Advantage) cover IV infusions if doctors deem them medically necessary.
Part B also includes home IV infusion equipment under the durable medical equipment benefit, including infusion medications, nursing visits, caregiver training, and patient monitoring. A person enrolled in Part C will get equivalent coverage to parts A and B.
A person needs to verify their hospital status — whether the hospital classifies them as an inpatient or outpatient — with their healthcare team. This can influence their out-of-pocket expenses and determine which part of Medicare will cover the services.
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