Does Medicare Cover Iron Infusions?

An iron infusion, often known as intravenous iron, is a treatment where iron is administered directly into the bloodstream. It is often used to help those who can’t take oral iron supplements or are not seeing much, if any, success with them. The purpose of an iron infusion is to replenish depleted iron stores in the body.

If you need this type of treatment, you may wonder, “Does Medicare cover iron infusions?” In this article, we answer the question in clear, plain English. You will also find the average cost of iron infusions if you have to pay out-of-pocket, as well as other helpful information.

Does Medicare Cover Iron Infusions?

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

Medicare Part A and Part B

Original Medicare (Medicare Part A and Part B) provides coverage for iron infusions. Original Medicare provides coverage for your iron infusions if it is considered medically necessary. Your healthcare provider must first order this treatment option in order for Original Medicare to provide coverage.

For Original Medicare to provide coverage for your iron infusions, at least one of the following must apply to your situation:

You are receiving hemodialysis
You have an iron deficiency because of chronic kidney disease
The patient is undergoing chemotherapy
You can’t tolerate oral iron pills or is unable to absorb the iron from an oral supplement sufficiently

Coverage for iron infusions is provided by Medicare Part A if your iron infusions take place in an inpatient setting. Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days.

Starting from the 61st day up to 90 days, Medicare Part A will still provide coverage. However, you will pay a copayment each day you remain in the hospital. 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 have to pay a higher copayment each day you are in the hospital.

Most of the time, however, coverage for iron infusions is provided by Medicare Part B. This is because iron infusions usually take place on an outpatient basis. And outpatient services fall under Medicare Part B. Once approved, Medicare Part B covers 80 percent of the costs of iron infusions. You will pay for the remaining 20 percent.

Medicare Advantage

Medicare Advantage plans (Medicare Part C) also provide coverage for iron infusions. These plans have to cover the same treatments that Original Medicare covers.

Part C plans may cover additional services as well. However, exactly what each Part C plan covers and how much the out-of-pocket costs are will vary depending on your plan’s specifics.

How Much Do Iron Infusions Cost?

The average cost of iron infusions can range from $400 to over $4,300. The specific type of iron infusion you receive and the facility where you receive it are key factors determining how much you will pay.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. 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.