Medicare pays a portion of Remicade infusion costs, but the amount you pay depends on which Medicare plan you have and whether you meet your deductible

Remicade (infliximab) is a biologic drug given by IV infusion to treat conditions like rheumatoid arthritis, Crohn's disease, and ulcerative colitis. Medicare Part B covers the drug itself when given in a hospital outpatient department or infusion center, but you will owe a percentage of the cost. Medicare Part D (prescription drug coverage) does not cover Remicade because it is administered by a healthcare provider, not dispensed at a pharmacy.

Under Part B, you pay 20% of the approved amount after you meet your annual deductible (which is $240 in 2024, though this changes yearly). The infusion center or hospital bills Medicare first, Medicare pays its 80%, and you receive a bill for your 20% share. The actual dollar amount varies widely because Remicade is expensive — the wholesale cost can exceed $2,000 per infusion — but your out-of-pocket cost depends on what Medicare's approved amount is in your area, not the full list price.

Key Takeaways

  • Medicare Part B covers Remicade infusions at 80% after you meet your $240 annual deductible, leaving you responsible for 20% of the approved amount.
  • The infusion must be given in a Medicare-approved setting such as a hospital outpatient department or independent infusion center for Part B to cover it.
  • If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower because those plans cover some or all of your Part B coinsurance.
  • Remicade is not covered under Part D because it is administered by a provider rather than picked up at a pharmacy.
  • Your actual bill depends on the Medicare-approved amount in your region, not the drug's list price, so costs vary by location.

How Part B Coverage Works for Infusions

When you receive a Remicade infusion at a hospital outpatient department or freestanding infusion center, the facility submits a claim to Medicare Part B. Medicare reviews the claim and pays 80% of what it considers the approved amount for that service in your geographic area. You are responsible for the remaining 20%, plus any amount above Medicare's approved limit if the provider is not a Medicare-participating provider (though most are).

The approved amount is set by Medicare and published in the Medicare Physician Fee Schedule; it is not the same as the drug's wholesale price or what uninsured patients might pay. For example, if Medicare's approved amount for a Remicade infusion in your area is $2,500, Medicare pays $2,000 and you owe $500. If the approved amount is $2,000, you owe $400. This is why your bill can differ from someone in another state receiving the same drug.

You must meet your Part B deductible first. Once you have paid $240 out of pocket toward Part B services in a calendar year, the 80/20 split begins. Until then, you pay the full approved amount for each infusion.

Medigap and Medicare Advantage Plans Can Lower Your Cost

If you have a Medigap (supplemental insurance) plan, it may cover some or all of your Part B coinsurance. Medigap Plan G, for instance, covers your entire 20% coinsurance after the deductible. Medigap Plan N covers 20% coinsurance except for certain preventive services. The exact coverage depends on which Medigap plan you own, so check your policy documents or call your Medigap insurer to confirm what they cover for infusions.

Medicare Advantage plans (Part C) also cover Remicade infusions, but the cost structure is different. Instead of the standard 20% coinsurance, you may have a copay per infusion, a coinsurance percentage, or both. Some Medicare Advantage plans charge $0 per infusion; others charge $50 or more. You will also have an out-of-pocket maximum, which limits your total annual spending on covered services. Once you reach that maximum, the plan covers 100% of remaining costs for the rest of the year.

If you are considering switching from Original Medicare to a Medicare Advantage plan or adding a Medigap policy, compare the infusion costs under each option. A plan with a low or $0 copay for infusions might save you hundreds of dollars per year if you receive Remicade regularly.

Where You Can Receive Remicade Under Medicare

Medicare Part B covers Remicade only when it is administered in a Medicare-approved setting. This includes hospital outpatient departments, independent infusion centers, and some physician offices with infusion capability. If your doctor's office does not have infusion equipment, they will refer you to one of these settings.

If you receive Remicade at a non-Medicare-approved facility or from a provider who does not accept Medicare assignment, you may owe more than the standard 20% coinsurance. Before your first infusion, confirm with the facility that they accept Medicare and are enrolled as a Medicare provider. You can search for Medicare-approved infusion centers on the CMS website or ask your rheumatologist or gastroenterologist for a referral to a facility they know accepts your coverage.

What Happens If You Have Not Met Your Deductible

Your Part B deductible applies to all Part B services combined, not just Remicade. If you have already paid $100 toward your deductible through other doctor visits or tests earlier in the year, you owe only $140 more before your infusions fall under the 80/20 split. Once the deductible is met, the 20% coinsurance applies to all remaining Part B services for the rest of that calendar year.

If your first Remicade infusion happens early in the year and the approved amount is high, you may meet your entire deductible with that single infusion. After that, you pay only 20% for the rest of the year. If you receive infusions later in the year, you might meet the deductible partway through the first infusion and then switch to the 20% rate for subsequent infusions that same year.

Biosimilars and Cost Differences

Biosimilars to Remicade — such as Inflectra, Renflexis, and Avsola — are now available and may cost less. These are not generic drugs; they are biologic medications designed to work the same way as Remicade but manufactured differently. Medicare Part B covers biosimilars at the same 80/20 rate as the original drug. If your doctor prescribes a biosimilar instead of Remicade, your out-of-pocket cost will depend on Medicare's approved amount for that specific biosimilar in your area.

Some people find that switching to a biosimilar lowers their costs because the approved amount may be lower. Others stay on Remicade if their condition is well controlled. Talk with your doctor about whether a biosimilar is an option for you, and ask the infusion center what the approved amounts are for each drug so you can compare your potential out-of-pocket costs.

Understanding Your Remicade Bill

After your infusion, you will receive an Explanation of Benefits (EOB) from Medicare showing what the facility charged, what Medicare's approved amount was, what Medicare paid, and what you owe. The EOB is not a bill — it is a record of the transaction. The actual bill comes from the infusion center or hospital.

Your bill should show the approved amount, Medicare's 80% payment, and your 20% responsibility. If you have a Medigap or Medicare Advantage plan, that plan's EOB will show separately what they cover. If the numbers do not match what you expected, contact the infusion center's billing department and ask them to explain the approved amount and your coinsurance calculation. Errors do happen, and it is worth checking.

Frequently Asked Questions

Does Medicare cover Remicade if I get it at home?

Medicare Part B covers Remicade only in approved clinical settings like hospitals and infusion centers, not in your home. Home infusion is a separate service that may be covered under different circumstances, but standard Remicade therapy is facility-based. Ask your doctor whether home infusion is an option for your condition and whether Medicare would cover it.

What if I cannot afford my 20% coinsurance?

Contact the infusion center's financial counselor or social worker. Many centers have programs to help uninsured or underinsured patients, and some drug manufacturers offer copay information cards that can reduce your out-of-pocket cost. You can also explore whether you may have access to for Medicaid in your state, which could cover costs Medicare does not.

Do I need prior authorization from Medicare before getting Remicade?

Medicare does not require prior authorization for Remicade itself, but your doctor's office or the infusion center may need to verify that you have Part B coverage and that the infusion is medically necessary. Your insurance company (if you have Medicare Advantage) may require prior authorization. Ask your doctor's office to handle this step before your appointment.

Will my out-of-pocket costs be the same every time I get an infusion?

Yes, as long as you have the same Medicare coverage and the approved amount does not change. Once you meet your deductible, you pay 20% of the approved amount for each infusion for the rest of that calendar year. The approved amount can change year to year, so your 2025 cost may differ from your 2024 cost.

Can I use a prescription discount card instead of Medicare for Remicade?

No. Remicade is not dispensed at a pharmacy, so prescription discount cards do not explore. You must use Medicare Part B. If you are uninsured or your coverage is inadequate, talk with your doctor about manufacturer information programs or clinical trials that might provide the drug at reduced cost.