Question about Medigap and Medicare

General Info, Questions

We recently received a question about Medigap and Medicare coverage.

Question: I have chronic inflammatory demyelinating polyneuropathy. I have to get IVIGs of gamunex-C. I have a nurse who comes in and gives me the IVIG which takes 6 hours. I am not house ridden, so is this covered by home health care?  It is very expensive and I am very lucky my supplemental health care in New York covers this after I meet the deductible.  I will be moving to North Carolina at the end of December and need to find out what Medicare covers and if there is a supplement that will help with the payment.

Answer: In order for Medicare to pay, you would have to be homebound. Patients are considered homebound if they meet these two criteria:

  1. Patients either need supportive devices such as crutches, canes, wheelchairs, and walkers; special transportation; or help from someone else in order to leave their home because of illness or injury, OR have a condition that makes leaving the home medically inadvisable.
  2. “There must exist a normal inability to leave home; and leaving home must require a considerable and taxing effort.”

You can check into Medigap, supplemental insurance through Medicare. Medigap is sold by private companies and can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Also look into Medicare’s prescription drug benefit (Part D).

For more information check out these sites: