What Does Medicare Pay for Blood?
This article was updated on: 09/15/2018
Does Medicare cover blood transfusions and related services?
Yes, Medicare generally covers blood transfusions as well as blood processing and handling services. These are the main coverage requirements:
- The blood transfusion is medically necessary. That is, a licensed doctor or other authorized health-care provider orders the transfusion, and Medicare agrees the care is necessary and proper.
- The blood transfusion and/or blood-related services are delivered by a health-care provider who accepts Medicare assignment.
What does Medicare pay for blood transfusions?
Medicare’s coverage of blood transfusions may depend partly upon where you receive the blood transfusion and where the health-care provider gets the blood.
Medicare Part A (hospital insurance) typically covers blood transfusions you receive in the hospital or in a skilled nursing facility. In some cases, you must pay for the first three pints of blood you receive during the calendar year. Thereafter, Medicare Part A generally pays its approved amount for any additional blood you need as well as blood processing charges. You may be responsible for the Part A inpatient stay deductible.
Sometimes the hospital or skilled nursing facility gets blood from a blood bank at no charge. In this case, you won’t have to pay for the blood or replace it. If the hospital or skilled nursing facility has to buy blood for you, you must either pay the hospital costs for the first three units of blood you receive during the calendar year or have the blood donated.
Medicare Part B (medical insurance) covers blood transfusions and blood processing services you receive in an outpatient setting. Similar to Part A coverage, Medicare Part B does not pay for the first three pints of blood you receive during a calendar year. If you receive blood from a donor or from a blood bank that does not charge for the blood, you will not have to pay for the first three pints of blood. You may be responsible for a copayment of the blood processing services. After you have met your Part B deductible (and paid for the first three pints of blood if charged), Medicare Part B will pay 80% of the Medicare approved amount for blood transfusion and blood processing services for the rest of the calendar year.
Do Medicare health plans cover blood transfusions?
Medicare Advantage plans are offered by private insurance companies that contract with Medicare to provide you with your Medicare Part A and Part B benefits, including blood transfusion and blood processing services. (The exception is that Part A, not your Medicare Advantage plan covers hospice benefits.)
Many Medicare Advantage plans provide expanded coverage and/or extra services, such as routine dental services. Contact your Medicare Advantage plan to find out whether your plan provides extra coverage, and what cost-sharing amounts you can expect to pay. Some plans require you to use health providers that participate in the plan’s network for blood transfusion and processing services.
On the other hand, if you purchased a Medicare Supplement (Medigap) plan from a private insurance company, your plan might help pay the portion of covered blood transfusions not paid by Medicare. These plans may help cover the first three pints of blood. Medicare Supplement plans might also cover at least part of the Medicare Part A or Part B blood transfusion coinsurance amount. Several Medicare Supplement plan types may cover Medicare deductibles.
If you have questions about blood transfusion coverage or need help understanding your Medicare coverage and options, I would be happy to help you. To schedule a time to speak together or have me email information to you, use the links below. If you’re ready to find plans now, you can use the Find Plans buttons on this page to browse plans now.
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