Medicare covers anemia, but the costs vary depending on your treatment type, severity, and cause of onset. Anemia is when your blood lacks red blood cells.
When this happens, your blood is unable to distribute oxygen throughout the body properly. Iron deficiency is the most common type of anemia, according to the National Heart, Lung, and Blood Institute.
Part B or Part D may cover the costs of treatment if your doctor suggests it’s medically necessary. The level of coverage varies depending on several factors.
Anemia Treatment Cost
Doctors use blood tests to diagnose anemia and to determine the underlying cause. On occasion, imaging tests are necessary.
The cost of therapy varies because there are many causes of the condition. Anemia treatments range from iron supplementation, observation, surgery, medications, or sometimes cancer treatment.
One of the most expensive anemia injections can cost upwards of $1,500 per vial. Others like Venofer cost $825, and the price of Ferrlecit was $412 in 2017.
Private insurance companies may charge more, and prices vary among plans and pharmacies. Before you take out a personal loan to try paying your medical bills, check around and ask your doctor for a cheaper alternative.
How Medicare Covers Anemia
If you are an inpatient in a hospital setting, Part A covers therapy during your stay. Coverage may include inpatient services such as blood transfusions, medications, injections, and surgeries.
Doctor’s visits for treatment and diagnosis of anemia is under Part B coverage. Outpatient drugs fall under Part B coverage, but only in certain situations.
Let’s use John as an example. He has kidney disease, and his doctor applies erythropoietin shots in the office to treat his anemia.
Part B covers 80% of John’s treatment costs. The remaining 20% is his obligation.
Also, Part B may pay for monthly vitamin B-12 or iron injections that you receive from your doctor as an outpatient service. Some patients need doses more often during the beginning or acute phases of anemia – Part B may cover the costs.
You must pay the Medicare deductible, coinsurance, and copayments. Supplement plans may help cover these costs.
Medicare Part D Drugs for Anemia
Medicare doesn’t pay for dietary supplements or vitamins. Enrolling in a Part D plan may help pay for drugs that Part B doesn’t.
Does Medicare Cover B12 Shots for Anemia Patients
Coverage for B-12 shots may be available for patients with pernicious anemia due to a B-12 deficiency. However, you may only receive shots once a month. Doses may range from 100 – 1000 micrograms.
In the acute phase of the condition, more frequent shots may be necessary. Medicare may cover the costs until the disease becomes manageable on a month-to-month dose.
Medicare may cover costs for B-12 shots when medically necessary and reasonable to treat certain conditions.
Specific disease types include megaloblastic or macrocytic anemias, fish tapeworms, and pernicious anemias.
Iron Shots for Anemia
Doctors may prescribe iron shots to treat iron deficiency anemia. Typically, iron deficiency treatment consists of diet changes or iron pill supplements.
Injections deliver an entire dose directly through the muscle. Two common side effects of iron shots are orange discoloration and internal muscle bleeding.
Shots are reportedly more painful than IV injections – many doctors prefer infusions over iron shots.
Does Medicare Cover Iron Infusions for Anemia Patients
Although, some cases require iron shots. You may need an IV infusion if you can’t take the supplements orally or absorb the iron through the gut.
Patients who suffer from blood loss may also need an IV iron shot. Other situations include needing to raise iron levels quickly to prevent further complications like needing a blood transfusion.
Medicare covers iron infusions after oral supplements don’t work. Coverage for IV infusions is also available for anemia caused by chronic kidney disease.
IV iron infusions have Medicare coverage when a doctor determines it’s necessary and reasonable for non-dialysis patients.
Anemia Causes and Treatment
There are multiple types of anemia diseases, and all of them have different underlying causes. The Mayo Clinic reports common anemia types to include chronic disease anemia, bone marrow disease anemia, hemolytic anemia, and both iron and vitamin deficiencies.
In the U.S., anemia is the most common blood disease, affecting about 6% of the population. Young children, women, and people with long-term illnesses are at higher risk of having anemia.
Certain types are genetic, and babies are sometimes born with the disease. Women have a higher risk of becoming iron-deficient due to blood loss from their menstruation periods.
Pregnant women are also at risk due to the body’s need for a more elevated blood supply demand. Older adults are high-risk due to other medical diseases and poor nutrition.
There are over 400 types of anemia, and they consist of three categories:
- Anemia due to blood loss
- Lack of red blood cell production
- Destruction of red blood cells
Treatment depends on the cause or type of anemia. Therapy options vary from severe to mild therapies such as chemotherapy, B-12 shots, IV iron infusions, iron shots, diet, and lifestyle changes.
How Can Medicare Supplements Help Cover the Cost of Anemia Treatment
Having any severe and chronic health conditions can be expensive without proper coverage. The right plan can save you from financial burdens.
With a Medigap plan, you can more confidently budget healthcare expenses, allowing you to worry more about your health than the cost of your healthcare.
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