Medicare Advantage & Infusion Coverage

What MA (Part C) is and how it affects infusion therapy at Idaho Infusion Center

Enrollment Dates You Should Know

ICEP (Initial Coverage Election Period)

7-month window around 65th birthday

AEP (Annual Enrollment Period)

Oct 15 – Dec 7 (switch plans or return to Original Medicare)

OEP (Open Enrollment Period)

Jan 1 – Mar 31 (one-time change for MA enrollees)

SEP (Special Enrollment Periods)

Triggered by life events (moving, losing coverage, etc.)

Quick Overview

– Private plan replacing Original Medicare
– Prior authorization often required
– Plan-specific copays/coinsurance + annual OOP max
– Must use in-network providers
– Medigap not available
– Limitations: High out-of-pocket costs often prevent infusion; some plans require biosimilars

How Coverage Works

Network & Eligibility Card: Confirm network rules; verify eligibility and referral requirements

Prior Authorization & Costs Card: Obtain PA, estimate copays/coinsurance, explain OOP max; note that high OOP may prevent infusion

Assistance & Alternatives Card: Help apply for copay cards or assistance programs; explain biosimilar requirements that may restrict infusion; coordinate alternative sites of care if needed

FAQs

PA Required?

Yes, most MA plans require prior authorization

Costs?

Plan-specific copays/coinsurance up to OOP max; sometimes too high for infusion here

Infuse Anywhere?

No, networks limit locations; biosimilar requirements may further restrict options

Educational purposes only
Coverage varies by plan; confirm with insurer or Medicare

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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