Does Medicare Pay for Blood Transfusions?
- Blood transfusions can be costly, but Medicare helps pay for services. Read on to learn how services are covered and your cost-sharing responsibilities.
Medicare pays for blood transfusions under Part A if it’s administered in a hospital inpatient setting and under Part B in an outpatient setting.
Your cost-sharing responsibility depends on several factors, including whether the blood was donated or purchased and if you're enrolled in a Medicare Advantage or Medigap plan.
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What Does Medicare Pay for Blood Transfusions?
Generally speaking, hospitals get blood for transfusions from blood banks at no cost. In this scenario, the individual doesn’t have to pay to use or replace the blood. Alternatively, the individual may donate blood for their own transfusion weeks ahead of surgery, or a friend or family member may donate blood specifically to them.
If the hospital has to buy the blood, the individual’s cost-sharing responsibilities depend on whether the transfusion is paid for under Part A or B. Regardless of the setting, Medicare covers the cost of blood after the first three units.
What Does the Individual Pay for Blood Transfusions?
Out-of-pocket costs for blood transfusions vary widely depending on whether the blood is purchased or donated and the setting it’s administered in.
If the hospital or health care provider gets the blood from a blood bank or if it’s donated specifically to the individual, Medicare covers the full cost of the blood transfusion.
However, if the hospital had to buy the blood, the person may have to share some of the costs.
Medicare Part A
In an inpatient setting, the individual has to pay for the first three units of blood they receive in a calendar year. This includes the processing and handling fees for each unit of blood, along with the blood itself.
Medicare Part B
If the blood is donated and used in an outpatient setting, the individual is responsible for the Part B copay for the processing and handling services, and the Part B deductible applies. If the provider has to buy the blood, the individual also pays for the first three units.
Does Medigap Cover Blood Transfusions?
Medicare Supplement Insurance (Medigap) plans are sold by private health insurance companies that comply with Medicare’s rules. These plans may reduce an individual’s out-of-pocket medical expenses, including costs related to blood transfusions.
Blood Transfusions and Medigap
Medigap policies supplement Original Medicare and can pay for some Medicare out-of-pocket costs, such as copays and deductibles. In all states except for Massachusetts, Minnesota and Wisconsin, there are 10 standardized plans.
All Medigap plans expand Medicare’s coverage for blood transfusions, with eight plans covering the first three units of blood and the other two covering a portion of the cost.
Blood Transfusions and Medicare Advantage
Medicare Advantage, also called Medicare Part C, is an alternative to Original Medicare. These plans are legally required to have at least as much coverage as Original Medicare, and they often have additional benefits such as prescription drug coverage or expanded coverage for medical services.
Benefits vary across plans, with some requiring policyholders to pay for their first three units of blood and other plans covering some or all of the costs.
