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does Medicare cover blood transfusions

Does Medicare Cover Blood Transfusions?

Blood transfusions in Original Medicare Standards can be a bit confusing. In fact, the process of blood transfusion itself is already confusing. But we are here to explain how it goes. 

The issue of Medicare and blood transfusions comes leads to a very common question for many which is “does Medicare cover blood transfusions?” In this article, we answer that question in clear, plain English. You will also find the average costs of blood transfusions if you have to pay out of pocket.

Does Medicare Cover Blood Transfusions?

The short answer is yes; Medicare will cover the cost of blood transfusions. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your blood transfusions. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for blood transfusions.

Parts A and B provide coverage for your blood transfusions if it is considered medically necessary. The operation must also be first ordered by your healthcare provider for Original Medicare to provide coverage. 

Coverage for a blood transfusion is provided by Medicare Part A if it takes place in an inpatient setting. Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days. For days 61 to 90, Medicare Part A will still provide coverage. However, you will pay a copayment of nearly $400 per day. After 90 days, Medicare Part A will no longer provide coverage.

However, Medicare Part A provides 60 “lifetime reserve days”. If you have them, they will still provide coverage for your hospital stay after 90 days, but you will pay for a copayment of close to $800 per day.

If you get into a hospital as an inpatient, then Medicare Part A will help cover the cost of blood you may need for a transfusion. Most of the time, hospitals can get blood from a blood bank for free. When this happens, then you don’t have to pay for it or replace it.

However, in cases where the hospital needs to buy the blood you need for transfusion, things are different. When this happens, you’ll have to pay for the first 3 units of blood you get each calendar year. Or you can donate the blood yourself (of have someone donate it for you) in order to replace what you use.  

Things work pretty much the same if you need blood in an outpatient setting. In this case Medicare Part B will provide coverage. If the provider gets blood from the blood bank for free, then you don’t have to pay for it or replace it. However, there will be a copayment for blood processing and handling.

If the provider has to buy the blood for you, you will have to pay for the first 3 units of blood you get each calendar year (just like with Part A). Or, again, you can donate the blood (or have someone you know donate it).  

Part C and Medigap Coverage for Blood Transfusions

Medicare Advantage plans (Medicare Part C) also provide coverage for blood transfusions. These Part C plans must cover everything Original Medicare covers. But they provide coverage for some things Original Medicare will not cover. The specifics of what a Part C plan covers and what the costs are will vary by plan.

Medicare Supplements or also known as Medigap, provides coverage for copayments for collection, storage, handling, and infusion charges per unit of blood that you need.

How Much Do Blood Transfusions Cost?

Blood transfusions generally cost between $900 to $3,500 per unit of blood. Many factors influence this cost including your blood type and the provider of the transfusion.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover Xtandi?

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