Does Medicare Pay for Blood Transfusions?
Medicare covers the full cost of blood used in transfusions if your hospital or other health care provider gets the blood from a blood bank or the blood is donated to you. You may have to pay some costs if the hospital or other provider has to buy the blood used in your transfusion.
When Does Medicare Pay for Blood Transfusions?
Medicare will help cover the cost of blood transfusions, but you may be responsible for the cost of the first three units of blood you receive each year.
How much of the cost Medicare covers depends on how much blood you receive, whether you receive it as a hospital inpatient or in an outpatient setting, whether it comes from a blood bank and whether you donate the blood beforehand or find a donor.
- Bleeding disorders – such as hemophilia
- Organ transplants
- Serious injuries – such as car crashes
- Sickle cell disease
Even though blood is often donated to blood banks, there are still handling and processing fees associated with the blood you receive in a transfusion. These include the cost of drawing the blood from a donor, testing, storage, transportation, salaries and other costs. You may be responsible for handling and processing fees in certain cases.
- A typical adult has nine to 10 pints of blood in their body.
- One in seven hospitalized patients in the United States require blood transfusions.
- A “unit” of blood is 525 milliliters — about a pint.
- The average blood transfusion requires about three units.
- People injured in a car accident may need as many as 100 units of blood.
Your Costs for Blood Transfusions Under Medicare
Your out-of-pocket costs for a transfusion can vary widely from less than $200 to well over a thousand dollars per unit of blood, depending on where the transfusion takes place and where the blood comes from.
Typically, you are responsible for the cost of the first three units of blood each year — unless it comes from a blood bank or it is donated specifically for your transfusion. You can donate blood ahead of time in some cases. A friend or family member may also donate blood on your behalf.
Original Medicare — Medicare Part A and Part B — cover blood transfusions in different ways and in different medical settings.
Medicare Part A Hospital Insurance
Medicare Part A hospital insurance covers your care if you receive a blood transfusion as a hospital inpatient.
Hospitals typically get their blood from blood banks. If that’s where the blood for your transfusion comes from, you pay nothing.
- You have to pay for the first three units of blood you receive each calendar year, or
- You have to replace the three units of blood through donations.
You are also responsible for your Medicare Part A deductible, which is $1,484 for each benefit period in 2021.
Medicare Part B Medical Insurance
Medicare Part B medical insurance helps cover blood transfusions you receive in an outpatient setting. You must be enrolled in Medicare Part B, and you will be responsible for your deductible — $203 in 2021.
You will be responsible for your Medicare Part B deductible, and you will have an out-of-pocket copayment for handling and processing services. This amount may vary depending on where you receive treatment.
If the health care provider is enrolled in Medicare and gets the blood from a blood bank, you will not have to pay for the blood and won’t have to replace the first three units through donations.
If the provider has to buy the blood, you have to either pay for the first three units or replace them through donations just as you would under Medicare Part A.
Do Medigap and Medicare Advantage Plans Cover Blood Transfusions
Medigap policies and Medicare Advantage plans may also affect how much you have to pay out-of-pocket for a blood transfusion. Both are sold by private insurers.
Medigap policies, also referred to as Medicare Supplement insurance, work with Original Medicare to help cover your out-of-pocket costs.
All Medigap plans cover your costs for the first three pints of blood each year. Medigap also covers all or part of your copayments and coinsurance, depending on which plan you have. Only Medigap Plan C and Plan F will cover your Part B deductible.
Medicare Advantage plans are sold by private insurers and replace Original Medicare coverage. Federal law requires that Medicare Advantage plans cover everything Medicare Part A and Part B cover, but they may provide additional benefits that Original Medicare does not offer.
Medicare Advantage plans vary widely in regard to the additional benefits they provide. While Original Medicare requires you to pay for the first three pints of blood in a calendar year, you may find a Medicare Advantage plan that will cover part or all of that cost for you.
You cannot have both a Medigap policy and a Medicare Advantage plan at the same time. You will have to choose one or the other.
9 Cited Research Articles
- Cataife, G. and Pagano, M.B. (2018, April 6). How Much Does a Blood Transfusion Cost? Retrieved from https://onlinelibrary.wiley.com/doi/10.1111/trf.14543
- Sutherly, B. (2021, April 28). Area Patients Charged Thousands for Blood Transfusions. Retrieved from https://www.daytondailynews.com/news/local/area-patients-charged-thousands-for-blood-transfusions/fciNCSlTAgGIlyQbCkuizN/
- Hemez, C. (2016, December 21). Blood Transfusion Costs. Retrieved from https://yaleglobalhealthreview.com/2016/12/21/blood-transfusion-costs/
- Palmer, J. (2014, July 5). What Many Donors Don’t Know: Their Blood Is Sold. Retrieved from https://www.oklahoman.com/article/4985779/what-many-donors-dont-know-their-blood-is-sold
- U.S. Centers for Medicare & Medicaid Services. (1996, May 24). National Coverage Determination (NCD) for Blood Platelet Transfusions (110.8). Retrieved from https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=44
- Forbes, J.M. (1991, May). Blood Transfusion Costs: A Multicenter Study. Retrieved from https://pubmed.ncbi.nlm.nih.gov/2020994/#:~:text=To%20this%20cost%20was%20added,to%20the%20patient%20was%20%24219
- American Red Cross. (n.d.). Importance of the Blood Supply. Retrieved from https://www.redcrossblood.org/donate-blood/how-to-donate/how-blood-donations-help/blood-needs-blood-supply.html
- National Heart, Lung and Blood Institute. (n.d.). Blood Transfusion. Retrieved from https://www.nhlbi.nih.gov/health-topics/blood-transfusion
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Blood. Retrieved from https://www.medicare.gov/coverage/blood