Medicare should cover the testing and treatment needed for anemia. It may depend on the specific procedure and whether it’s medically necessary. You may also need a Medicare plan with prescription drug coverage.
Anemia is when there aren’t enough red blood cells in your body. Multiple types of anemia exist, and each type may have different causes. For example, heart disease could cause anemia or it could happen because you’re not getting the vitamins your body needs.
Medicare should cover testing and treatment for anemia if the recommended services are deemed medically necessary, though experimental treatments may not be covered. Medicare may require documentation of the anemia diagnosis from your doctor.
Depending on your needs, you may be covered by Original Medicare (Part A and Part B) or by Part D.
Another option is Medicare Part C, also known as Medicare Advantage. An Advantage plan covers all the same services as Original Medicare and often includes coverage beyond Original Medicare, including prescription drug coverage.
With Original Medicare, you can also get Medigap. This is supplemental insurance that helps cover the out-of-pocket costs of Original Medicare. You cannot have Medicare Advantage and Medigap simultaneously, though.
With Medicare Advantage and Medigap, your coverage will depend on your specific plan.
This article discusses common anemia testing and treatments and whether Medicare covers them.
Iron infusions may be necessary for treating iron-deficiency anemia.
Medicare should pay for these infusions under Part B in cases where oral iron supplements cause stomach issues or are not properly absorbed due to anatomical or other illness-related reasons, such as when undergoing chemotherapy.
They may also be covered if you continue to lose iron despite taking oral supplements or if you are a pregnant person at risk of complications.
Learn more about what to expect from an iron infusion.
In severe cases of anemia, you may need to replenish blood to improve oxygen levels. You may also need help stabilizing from shock due to conditions like hemolytic anemia.
In these cases, blood transfusions in the hospital are covered under Part A. If you need to get a transfusion as an outpatient, it will be covered by Part B.
Learn more about blood transfusion for anemia.
Without treatment, a vitamin B12 deficiency can cause pernicious anemia, which occurs when the body lacks sufficient B12 to produce enough red blood cells.
Medicare will cover these injections if you have a history of deficiency or conditions that cause this deficiency, such as anemia. As with transfusions, Part A will cover in-hospital shots, and Part B will cover outpatient shots.
Medicare Part A covers most necessary blood tests. Your healthcare team can request these tests as part of inpatient hospital care, skilled nursing services, hospice care, home health services, or any other applicable covered services.
According to Medicare coverage guidelines, Medicare Part B covers blood tests ordered on an outpatient basis that are deemed medically necessary to screen for anemia.
These may include tests such as a complete blood count (CBC) to check your hemoglobin levels and other tests, such as the 25-hydroxy vitamin D test or the vitamin B-12 test, to look for vitamin deficiencies associated with anemia.
However, if you get a panel test that checks for more than one nutritional deficiency, Medicare may not consider it medically necessary or cover it.
Learn more about whether Medicare covers blood tests.
Medications you may need to take if you’re living with anemia include erythropoiesis-stimulating agents that help increase your blood cell count. These are covered under Part B if you have anemia or end stage renal disease.
Oral iron or other vitamin supplements, however, are not covered.
You may also need various other drugs if you have another underlying condition that’s triggering your anemia.
For example, if a heart condition causes your anemia, you’ll need treatments that help your heart. If your bone marrow causes your anemia, you might need a bone marrow transplant.
If included in the formulary, many of these should be covered under Part D. Their price will depend on their tier.
Learn more about Medicare prescription drug plans (Part D).
Tips for choosing a Medicare plan if you have anemia
- Make sure you have prescription drug coverage.
- Compare the costs of Part D and Advantage plans in your area.
- Check the formulary (list of covered drugs) of Part D and Advantage plans to make sure the supplements you need are included.
- Consider a Medigap plan if you think you might need blood transfusions.
How do I bill Medicare for B12 injections?
Your medical professional will submit the injection cost to Medicare directly for payment.
How much should a B12 shot cost?
The list price of one package of B12 varies depending on the pharmacy between about $20 and $50. That said, Medicare should cover it fully if you’ve already met your deductible.
Is anemia considered a disability?
This depends on the type of anemia you have. Some types, like hemolytic anemias, are considered as a disability by the Social Security Administration. If you get disability benefits, you are eligible for Medicare coverage before age 64 years.
Medicare will cover the diagnosis and treatment of anemia. There are multiple types of anemia, and your treatment will depend on which kind you have.
Medicare will cover your treatments for all types of anemia as long as the treatment is medically necessary. It may help to have a prescription drug plan, especially if you know you’ll need supplements to treat your anemia.