Iron deficiency can occur for a number of reasons, but those who have certain chronic medical conditions can be at a higher risk for anemia. Iron infusions may be prescribed to treat the symptoms of anemia, but Medicare coverage for this type of treatment may be available only for recipients with qualifying conditions or circumstances.
Understanding Iron Infusions
Although iron deficiency can often be addressed through lifestyle changes or with dietary supplements, iron infusions are sometimes necessary for people who have an extreme deficiency or may not be able to tolerate ingesting iron through supplementation.
There are three common types of intravenous iron preparations:
- Iron sucrose. This iron replacement product is administered through a slow infusion over 2-5 minutes or, when mixed with another fluid, anywhere from 15 minutes to 4 hours. A brand name for this preparation is Venofer.
- Ferric carboxymaltose. The usual prescription for this preparation is two doses given about 7 days apart. It may be administered under the brand name Injectafer.
- Iron dextran. This preparation can be administered in large doses when necessary, which is common after certain surgeries or extreme situations. Brand names include Dexferrum and Infed.
If your doctor prescribes iron infusions to treat anemia, your dosage will depend on your height and weight. Your response to initial treatment will also determine how many treatments you may need over the course of your treatment plan. Maintaining this schedule as directed by your health care team is essential for the success of this plan.
Side Effects and Risks Associated with Iron Infusions
Discomfort, itching or swelling at the injection site are some of the most commonly reported side effects with iron replacement infusions. Some patients also report that the taste of their food or drinks changes temporarily. Others have reported experiencing nausea, vomiting, headaches or cramps and pain in muscles and joints.
Your doctor may monitor your blood pressure or your heart rate before, during and after your infusion. This may last for up to half an hour after your infusion in some cases. While rare, iron toxicity or an allergic reaction to the preparation may occur. The first dose you receive for an iron infusion may be small and meant to test for any allergic reaction.
Some medications and supplements can disrupt the way your body absorbs iron. Be sure your health care team is aware of any prescription or over-the-counter medications or supplements you may be taking. Side effects of receiving iron infusions may not appear immediately, so monitor any changes and inform your doctor about any complications or discomfort.
Medicare Coverage for Iron Infusions
Generally, iron infusions are administered in an outpatient setting. Medicare insurance through Part B applies to these circumstances, which means you may have cost-sharing responsibilities associated with any relevant deductibles, copays and coinsurance amounts if your condition qualifies this treatment for coverage. If a Medicare recipient requires an iron infusion during an inpatient stay following a surgery, Part A and its applicable share-of-cost terms apply.
Medicare insurance coverage looks at the medical condition and the medical necessity of the treatment when determining approval. Iron infusions are most commonly considered medically necessary for recipients who receive hemodialysis or have an iron deficiency because of chronic kidney disease. Recipients undergoing certain types of chemotherapy may also qualify for coverage of iron infusions.
A recipient who is iron deficient but cannot tolerate oral iron pills or is unable to absorb the iron from an oral supplement sufficiently may also be approved for coverage with Part B. This requires appropriate documentation from the primary care physician in order to receive Medicare’s authorization for the treatment.
While Medigap or Medicare Advantage plans may not offer extra benefits that include enhanced coverage for iron infusions, they may help reduce out-of-pocket expenses when it comes to deductibles and copays associated with your treatment. These plans are managed by private insurers, so terms are set by the individual carriers and may not be available in every state.
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