A blood transfusion can be a life-saving procedure when you’ve lost blood due to illness or injury. Transfusions are usually performed in a hospital, outpatient clinic, or doctor’s office. Your Medicare coverage will depend on where you get blood and what insurance plan you have.
How Medicare Helps Cover the Cost of a Blood Transfusion
Medicare Part A (Hospital Insurance) Part A will help cover the cost of blood you get in a hospital as an inpatient. In most cases, a hospital will get blood for free from a blood bank. If this is the case, you will not be responsible for replacing it or paying for it. If the hospital has to purchase it, you must have the blood donated, or pay the hospital for the first 3 units of blood you get within a calendar year.
Medicare Part B (Medical Insurance) Part B will cover blood you get as a hospital outpatient. If your provider gets blood from a blood bank at no charge, you will not have to replace it or pay for it. You will have to pay a copayment for the blood processing and handling services, and the Part B deductible applies. If your provider has to purchase blood, you will have to pay the provider costs for the first 3 units of blood you get in a calendar year or have the blood donated.
While hospitals do not charge for the blood itself, they generally charge for blood processing and handling for every unit of blood you get, regardless of whether the blood was donated or purchased. Part A will cover these charges if you receive your transfusion as a hospital inpatient. Part B will cover this service if you are an outpatient. If you have Original Medicare, you will pay a copayment. The exact cost of your service will depend on if your physician accepts assignment, and if you visit a participating provider.
If you have Original Medicare, you may have purchased a Medigap policy to supplement your insurance. Even though Original Medicare covers many costs, a Medicare Supplement (Medigap) plan will help cover some of the out-of-pocket expenses, such as deductibles, copayments, and coinsurance. All Medicare Supplement plans provide coverage for blood transfusions to help cover the copayment for the collection, storage, handling, and infusion charges per unit of blood that you need.
If you are enrolled in a Medicare Advantage plan, you will have at least the same amount of coverage as Original Medicare. Many MA plans offer additional benefits, as well. If you are enrolled in an HMO (Health Maintenance Organization), you will likely have to visit doctors and hospitals within your plan’s network. Contact your plan directly if you have questions regarding their coverage for blood transfusions.