Medicare Coverage of Infusion Pumps
What It Is
Rental of an infusion pump, used to deliver medication, nutrients, and/or hydration, for use in a patient's home
Medicare Part B covers the rental of an infusion pump if prescribed by a doctor. The pump must be rented from a Medicare-certified medical equipment supplier.
If an infusion pump is prescribed for the infusion of prescription medication, Medicare Part B may also cover the medicine itself.
If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for infusion pumps, contact the plan directly.
What Medicare Pays
Medicare Part B pays 80 percent of the Medicare-approved amount for rental of the infusion pump and for covered medicines.
Warning: If the pump is rented from a Medicare "participating supplier," the supplier can't charge more than the Medicare-approved amount. However, a supplier who's enrolled in Medicare but isn't an officially "participating" supplier may charge more than the Medicare-approved amount. In that case, the patient must personally pay the difference between the Medicare-approved amount and the amount the supplier actually charges (on top of the 20 percent of the Medicare-approved amount that Medicare doesn't pay).
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.