Does Medicare Cover Anemia?

Does Medicare Cover Anemia

Most anemia patients can be treated with supplements and lifestyle changes, but some may require a blood transfusion.

Anemia is the most common type of blood disorder, affecting over 3 million Americans. It occurs when your body doesn't have enough red blood cells, lowering your oxygen levels.

This page looks at the symptoms, testing, and risk factors for anemia. Then, we’ll help you understand the types of anemia and the Medicare coverage for diagnosis and treatment.

Symptoms of anemia

Those who have anemia often report feeling weak and tired. You may also experience shortness of breath and pale or yellowish skin. In addition, some people with anemia feel light-headed and have cold hands and feet. A headache and racing pulse may also be symptoms of anemia.

Some people with anemia have an inflamed, sore tongue and brittle nails. You may also have cravings for ice, dirt, or starch.

Testing for anemia

If you have anemia symptoms, your medical provider may order a Complete Blood Count (CBC) as well as additional tests to measure the number, shape, and size of the red blood cells in your body. Other tests may check your blood’s hemoglobin levels. Following an anemia diagnosis, you might need additional tests to find the cause.

Risk factors for anemia

Infants, children, and menstruating women are at risk of developing anemia – as are vegetarians and frequent blood donors.

Causes of iron-deficiency anemia

Iron-deficiency anemia is the most common type of anemia. It occurs when the body doesn’t have enough iron to produce hemoglobin. (Hemoglobin is the part of red blood cells that carries oxygenated blood throughout your body.)

If you aren’t consuming enough iron (or are losing too much iron,) your body won’t produce enough hemoglobin. This may lead to iron-deficiency anemia.

Common causes of iron-deficiency anemia include the following:

  • Heavy menstruation – or slow, chronic blood loss from a peptic ulcer, a hiatal hernia, a colon polyp, or colorectal cancer — can cause iron-deficiency anemia.
  • Consuming too little iron can lead to iron-deficiency anemia.
  • Intestinal disorders, such as celiac disease, can lead to iron-deficiency anemia.
  • Many pregnant women become anemic.

Other types of anemia

There are other types of anemia besides iron-deficiency anemia.

You may become anemic from a vitamin deficiency.

Infections, autoimmune disorders, or heart abnormalities may cause hemolytic anemia, which causes your red blood cells to break apart in your bloodstream.

Sickle cell anemia causes a person's red blood cells to flow through their blood vessels incorrectly, leading to blockages and interrupting their circulation.

Sometimes anemia is caused by other conditions and treatments. For example, some with end-stage renal disease (ESRD) or cancer develop anemia.

Finally, severe infection or exposure to toxins can cause aplastic anemia, which causes your bone marrow not to make enough blood cells.

Medicare coverage for anemia

Medicare will cover anemia, regardless of type, symptoms, or cause. Your out-of-pocket costs include monthly premiums, deductibles, and coinsurance or copayments.

Here’s a breakdown of what each part of Medicare covers:

Medicare Part A (hospital insurance)

If your anemia treatment requires a hospital stay, Medicare Part A will cover the treatment. For example, you may need to be hospitalized for a blood transfusion, which Medicare Part A covers.

Medicare Part B (medical insurance)

Medicare Part B covers doctor visits, diagnostic blood tests (such as the CBC test), and B12 or iron injections – as long as your doctor verifies that supplements haven’t helped you.

If kidney failure causes you to be anemic, Medicare Part B may cover ESA injections given at your doctor’s office.

And Medicare will pay for IV infusions and blood if you’ve experienced blood loss, your body can’t absorb iron, or you have ESRD. These treatments must be given in an outpatient setting for Medicare Part B coverage.

Medicare Part C (Medicare Advantage)

Insurance companies offer Medicare Advantage plans. Medicare Advantage plans must cover everything that Original Medicare covers, with most (99%) covering additional items as well.

If your Advantage plan includes an OTC card, you may be able to use that to pay for non-prescription medications, such as iron or folic acid supplements.

Comparing Medicare plans is easy with our Find a Plan tool. Just enter your zip code to review the costs and coverage of Medicare plans in your area. You can also call us toll-free at 888-992-0738 to have a licensed Medicare agent answer your questions and explain your Medicare options in easy-to-understand language.

Medicare Part D (prescription drug coverage)

If prescribed by a doctor, your Medicare Part D plan will cover iron, vitamin B12, or folic acid supplements. These plans do not cover over-the-counter medications, though.

Medicare Supplement Insurance (Medigap)

Medigap plans help cover your share of costs under Original Medicare. Depending on your plan, a Supplement plan may cover your coinsurance or even pay for the first three pints of blood if you need a transfusion.

Out-of-Pocket Costs for Anemia Treatments

As we mentioned, you may be required to pay your monthly premium, deductible, and copayment or coinsurance. There may also be additional out-of-pocket expenses when treating your anemia.

For example, if your provider has to buy blood for you, you must either pay for the first three units of blood you get that year – or use blood you or someone else donated for your use.

It’s also worth noting that your healthcare provider may recommend you get treatments more often than Medicare covers. Or your doctor may recommend a treatment that Medicare doesn’t cover. If this happens, you may be responsible for some or all of those costs.

Finally, your out-of-pocket costs are also determined by other insurance you might have, how much the doctor charges, whether the doctor accepts Medicare assignment, and the type of facility where you receive medical services.

Additional resources

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