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Insurance
Assistance
Understanding your insurance is an important part of taking care
of yourself. There are many resources to help you obtain and use
insurance effectively, but a key first step is to learn about
different types of insurance, including benefits and limitations
of each type of insurance.
An excellent starting point in understanding insurance is Chapter
XVII of the IDF Patient/Family Handbook – Health
Insurance for Primary Immune Deficiency: Taking Control.
Please also note this additional new information about health
insurance for patients with PI.
- Medicare Part B will cover selected drugs and drugs administered by a physician, such as IVIG. Medicare will cover IVIG in the hospital outpatient clinics and in physicians' offices. As of January 1, 2004, Medicare will cover IVIG therapy when provided for home administration. However, Medicare will only cover IVIG for Primary Immune Deficiencies (PID), and only the drug itself is reimbursable under Medicare Part B. All other ancillary services will not be covered when IVIG is provided in the home.
- Beginning January 1, 2006, Medicare implemented a new prescription drug plan (Medicare Part D) to provide beneficiaries with additional drug coverage that may or may not be currently covered under existing Medicare programs. The new Medicare Part D program is administered through qualified Medicare Prescription Drug Plans (PDPs). In some instances, IVIG therapy may be a covered benefit under the Part D program. Individuals who currently have Medicare coverage should evaluate all options available under their existing Medicare plan, or through the prescription drug plans offered in their respective State. Information regarding the new prescription coverage under Medicare Part D can be found at www.medicare.gov, or by calling 1-800-MEDICARE.
- The Medicare program is now administered by the Centers for Medicare and Medicaid Services (CMS). The Health Care Financing Administration (HCFA) no longer administers the Medicare Program.
- Another prepaid/managed care plan is the Point of Service (POS) Plan: This plan is a type of managed care plan in which members can choose how they will receive services-whether through an HMO, PPO, or fee-for-service plan-when the medical services are needed (at the point of service).
- Your physician may be paid directly by your insurance plan under a certain contracted rate. You may receive a bill for the difference, and it is your responsibility to contact your provider to determine your liability.
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