Original Medicare & Medigap Coverage

Why this matters for infusion patients.

Original Medicare → 80% covered, patient responsible for 20%.
Medigap → supplemental policy to cover part/all of 20%.

Official timelines for Original Medicare & Medigap, plus Idaho-specific rule.

Enrollment Dates You Should Know

Initial Enrollment Period (IEP)

7-month window around age 65 (3 months before, birthday month, 3 months after)

General Enrollment Period (GEP)

Jan 1–Mar 31 if you miss IEP; penalties may apply.

Medigap Open Enrollment


6-month window starting when you’re 65+ and first enroll in Part B; no health underwriting.

Idaho Medigap “Birthday Rule”

63-day window after your birthday to change to equal/lesser Medigap plan without underwriting.

How Coverage Works

Original Medicare Card

Medicare pays 80% of infusion service costs.
Patient pays 20% coinsurance after deductible.
No prior authorization required.
No annual maximum OOP.
How the infusion center handles it (eligibility checks,
estimates, assistance if needed).
Medicare.gov for more info.

Medigap Card

Only available with Original Medicare.
Covers part/all of the 20% Medicare doesn’t pay.
Provides predictable costs.
How the infusion center handles it (verify benefits, reduced costs).
Medigap resources for more info

Key Takeaway

Original Medicare + Medigap = minimal out-of-pocket costs for infusion patients.

Educational purposes only.
Coverage depends on plan; confirm with Medicare or your insurance provider.

Are You Ready

Schedule Your Appointment Today.

Our infusion nurses have 10+ years of experience, and an on-site provider ensures safety throughout treatment.

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