Does Medicare Cover Blood Transfusions?
Key Takeaways
- Blood transfusions may be covered by Medicare Part A in an inpatient facility or by Part B in an outpatient setting.
- If your healthcare provider purchases blood, you are responsible for the costs of the first three units you receive each year.
- A Medicare Advantage plan from a private insurance carrier may offer additional coverage for blood transfusions.
- A Medicare Supplement plan can help with some or all of the out-of-pocket costs for a blood transfusion.
Original Medicare, the public health insurance program for U.S. adults who are over 65 or have certain disabilities, covers blood transfusions when they are medically necessary and provided at a Medicare-approved facility. Coverage for blood transfusions could fall under Medicare Part A, which is hospital insurance, or Part B, which is medical insurance, depending on where you receive the transfusion.
The cost of blood transfusions depends on factors like the availability of the correct blood type. If you have either a Medicare Advantage plan or a Medicare Supplement plan from a private insurance carrier, that coverage may help with any out-of-pocket costs. Learn more about how Medicare covers blood transfusions.
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Why Would I Need a Blood Transfusion?
Original Medicare covers blood transfusions when deemed medically necessary. There are several reasons why you may need donated blood:
- Severe blood loss from trauma or an accident.
- Blood disorders like anemia or sickle cell disease.
- Certain cancer treatments that can destroy your red blood cells.
Blood transfusions are usually safe and considered an essential procedure. For a successful transfusion, it’s crucial to use a compatible blood type. The four main types are A, B, AB, and O. Each of these may be either positive or negative for a protein called the Rh factor.
Donated blood can be essential to save someone’s life. However, in 2024, the American Red Cross warned that a drop in donations had resulted in a blood shortage. There’s an especially great need for Type O blood:
- Type O positive blood is the most common blood type and compatible with other positive blood types.
- Type O negative is much rarer but can be given to anyone, so it’s often used in cases of trauma where healthcare providers may not know the patient’s blood type.
A lack of supplies can impact blood transfusion costs if it means your healthcare provider must buy blood for your transfusion.
How Medicare Covers Blood Transfusions
Original Medicare covers blood transfusions that are medically necessary and performed at a Medicare-approved facility. Let’s look at how Medicare Part A and Part B cover blood transfusions:
- Medicare Part A covers blood transfusions received as an inpatient in a hospital while Medicare Part B covers blood transfusions in an outpatient setting.
- You may receive donated blood through a blood bank, provide your own before a procedure, or have blood donated by another person.
- If the healthcare provider purchases blood, you must pay the costs for the first three units.
- After the first three units of blood, Medicare covers any more that’s needed for the rest of the year.
- For each unit you receive as an outpatient (covered by Part B), you’re charged a copayment for the cost of processing and storing the blood.
How Medicare Advantage Covers Blood Transfusions
Medicare Part C plans, known as Medicare Advantage, are offered by private insurance carriers to substitute for Original Medicare. Plans are legally required to offer at least the same coverage as Original Medicare, including for blood transfusions. They may also feature lower costs and additional benefits that aren’t provided by Original Medicare, such as paying some or all of the costs for the first three pints of blood.
Benefits and costs vary by plan, and availability depends on where you live. To get the most out of their coverage, people on Medicare Advantage plans must visit doctors and hospitals that are in their provider network.
How Medicare Supplement Plans Cover Blood Transfusions
Medicare Supplement plans, also called Medigap, are provided by private insurance carriers to help with the costs that Original Medicare doesn’t pay. People on Original Medicare may choose to switch to a Medicare Advantage plan or to add a Medicare Supplement plan, but they can’t do both.
There are several standardized Medicare Supplement plan types available in most states. Most pay the full cost of the first three units of blood. The exceptions are Plan K, which pays 50% and Plan L, which pays 75%.
How Much Blood Transfusions Cost With Medicare
A study conducted in December 2021 found the average cost of a red blood cell transfusion without insurance was $2388.
With Medicare coverage, what you spend for a blood transfusion depends on whether the provider must purchase the blood or if it is obtained through a blood bank. Blood received from a blood bank is free, though you may be charged a copayment for the cost of processing and storing the blood under Medicare Part B. If blood must be purchased, the beneficiary is responsible for the costs of the first three units.
Medicare Advantage plans offer different cost structures for premiums, deductibles, and coinsurance, which can affect how much you spend on a procedure that requires blood transfusions.
Medicare Part A
- Part A covers inpatient care in facilities such as hospitals and skilled nursing facilities.
- Premium: Most people don’t pay a monthly premium for Part A if they or their spouse have paid Medicare taxes for at least 10 years.
- Deductible: This is the amount beneficiaries are responsible for before Medicare pays. For 2025, the deductible is $1,676.
- Coinsurance: After 60 days of hospitalization, beneficiaries pay a daily coinsurance, which increases after 90 days. Extended hospital stays may require higher coinsurance payments.
Medicare Part B
- Part B covers outpatient medical care.
- Premium: Most people pay a standard monthly premium ($185 in 2025, though it can be higher based on income).
- Deductible: In 2025 the deductible is $257
- Coinsurance: After the deductible, Medicare typically covers 80% of the cost of approved services, leaving the beneficiary to pay the remaining 20%.
Medicare Advantage
- Costs may vary significantly depending on the plan.
- Premium: Some Medicare Advantage plans have a low or $0 monthly premium, though beneficiaries still need to pay the Part B premium.
- Deductible: Some plans have an annual deductible, but not all do.
- Coinsurance/Copayments: Plans set copayments or coinsurance rates for services such as doctor visits or hospital stays.
- Out-of-pocket maximum: Medicare Advantage plans have an annual out-of-pocket maximum, which caps the amount beneficiaries pay for covered services. Once this maximum is reached, the plan covers 100% of approved services for the remainder of the year.
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Putting It All Together
Blood transfusions are medically necessary procedures that save lives. Cost and coverage of blood transfusions and blood products vary depending on where the transfusion is performed, and whether the provider gets the blood for free or has to buy it. People on Medicare are responsible for three units of blood in a calendar year. Contact a licensed insurance agent to learn more about your coverage options.
Sources
Blood. Medicare.gov.
United States blood pricing: A cross-sectional analysis of charges and reimbursement at 200 US hospitals. American Journal of Hematology.
Red Cross national blood inventory plummets 25% in July —declares emergency blood shortage. American Red Cross.