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Medicare Home IVIG Benefit: FAQs

January 19, 2023

On December 29, 2022, President Biden signed the Fiscal Year 2023 Omnibus legislation (H.R.2617) passed by Congress that included a provision mandating coverage for the supplies and services required for Medicare beneficiaries with PI to receive IVIG at home beginning January 1, 2024. 

Q: I am currently a Medicare beneficiary with PI, is there a way for me to get coverage for home IVIG now? 

A: Yes. The Medicare IVIG Demonstration Project was created in 2014 as the result of IDF advocacy. This demonstration project, which has been renewed twice, allows enrolled individuals with PI to receive Medicare coverage for the medication, services, and supplies needed for home IVIG. The demonstration will expire on December 31, 2023. See the instructions below on how to enroll. 

Q: How do I enroll for the demonstration?  

A: Make sure to consult with your medical provider to assist you with the application. You and your physician will need to sign the form. To be eligible for the demonstration, the beneficiary must:  

  • Be covered under Medicare Fee-For-Service and enrolled in Part B, 
  • Have a diagnosis covered by Medicare Part B
  • Receive immunoglobulin treatment by intravenous infusion (IVIG),
  • Not be currently covered under a home health episode of care (i.e., home health agency in the home for IV antibiotics, physical therapy, etc.), and  
  • Not be enrolled in a Medicare Advantage Plan. 

The program is managed by Noridian Healthcare Solutions, which has online resources on the Medicare IVIG Demonstration aimed at beneficiaries and applicants.  

Noridian Healthcare Solutions' webpage for the Medicare IVIG Demonstration Project: 

Q: What is the timeline from when I apply to when I can receive services at home?  

A: If you submit a fully completed application to Noridian healthcare services, the CMS contractor, by the 15th of the month and if you are determined eligible, then you will have coverage effective the first of the next month. For example, if an application is received on September 15, coverage will be effective October 1.  

If your completed application is received after the 15th of the month and if you are determined eligible, you will have coverage effective the fifteenth of the next month.  For example, if an application is received on September 20, coverage will be effective October 15. 

Q: What happens when the IVIG demonstration expires at the end of the year?  

A: The Medicare permanent benefit will begin on January 1, 2024. Those who are already enrolled in the demonstration project will be able to receive ongoing coverage through Medicare B without having to re-enroll. 

Q: I use SCIG at home. As a Medicare beneficiary, do I need to enroll in the demonstration to ensure coverage? 

A: No. SCIG infusions are covered under Medicare B or D, depending on your diagnosis code. If you have a Medicare B qualifying diagnosis, you do not need to be enrolled in the IVIG Demonstration Project as Medicare and your supplemental (secondary, MediGap) plan already cover supplies and administration services. The IVIG Demonstration Project only applies to individuals on IVIG, not SCIG, who have a Medicare Part B qualifying diagnosis. 

Q: My specialty pharmacy provider told me that I would not be able to receive home IVIG through them. What should I do? 

A: Consult with your medical provider and apply for IVIG demonstration enrollment. Noridian will work with you to find a specialty pharmacy in your area that will provide services through the demonstration.  

Q: How do I check the status of my enrollment application?  

A: Beneficiaries with any IVIG Demonstration inquiries may contact Noridian Healthcare Solutions at 1-844-625-6284, Monday-Friday, 8:30 a.m. – 4 p.m. CT. Please notify your specialty pharmacy’s billing department once you receive acceptance into the program so it can be added to your billing profile. 

Still have questions? Contact us through AskIDF.