Some parts of Medicare cover medically necessary clinical diagnostic lab services, such as blood tests. Iron infusions may only be covered under certain circumstances.
Medicare Part B covers clinical diagnostic lab tests, such as a complete blood count (CBC). It may also cover iron infusion as an outpatient procedure if a person meets certain requirements.
Part A can cover medically necessary iron infusions in a hospital setting, such as after surgery.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
A doctor may prescribe iron infusions to treat anemia, but only some people qualify for Medicare coverage for this treatment.
Lifestyle and diet changes are usually enough to treat iron-deficiency anemia, but people with severe cases may need an iron infusion. An iron infusion may also be helpful for people who cannot properly ingest or absorb iron supplements.
Medicare may cover intravenous (IV) iron infusions for people who:
- receive hemodialysis or have an iron deficiency because of chronic kidney disease (CKD)
- need an iron infusion after surgery
- are undergoing certain types of chemotherapy
- have an iron deficiency but cannot tolerate or ingest oral iron pills
Generally, people receive iron infusions in an outpatient setting, which means Medicare Part B applies.
This means the person may have to share the cost of any relevant deductibles, copays, and coinsurance amounts if they qualify for coverage.
The cost is usually 20% of the Medicare-approved amount for doctors and other healthcare professionals’ services, as well as a copayment to the hospital for the IV service.
In most cases, this copayment won’t exceed the Part A hospital stay deductible amount.
Part B can also cover iron infusions for those who cannot tolerate or absorb oral iron supplements, but there needs to be appropriate authorization from a Medicare-approved healthcare professional.
If a person needs an iron infusion during an inpatient stay after surgery, Medicare Part A applies.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare Part B covers some clinical diagnostic lab services. If a doctor decides that a CBC blood test is medically necessary, Medicare may cover it. The doctor must use a Medicare-approved laboratory service.
Laboratory tests usually covered by Medicare include:
- certain blood tests
- urinalysis
- tests on tissue specimens
- some screening tests
If a person has enrolled in Medicare Advantage, the plan provides the same basic coverage as Original Medicare (parts A and B).
A person will need to check with their Advantage plan provider if their plan covers clinical diagnostic lab services to diagnose anemia.
Learn more about Medicare coverage of blood tests.
Prescribed drugs
Medicare Part D offers coverage for prescription drugs, such as vitamins, iron, or folic acid supplements.
Learn more about Part D drug coverage plans.
If a person’s iron infusion is covered under Medicare Part B, they will have to pay 20% of the Medicare-approved amount for the doctor’s services, as well as a copayment to the hospital.
This amount depends on the healthcare professionals and the setting.
In 2024, Medicare Part B costs around $174.70 each month, with a yearly deductible of $240 before Original Medicare starts to pay.
If a person’s iron infusions are covered under Medicare Part A — for example, if they need infusions during an inpatient stay following surgery — they may not have to pay any extra costs.
However, for Part A, there is a $1,632 deductible for each inpatient hospital benefit period before Original Medicare starts to pay.
Costs of other anemia tests
In general, a person has no additional costs for diagnostic laboratory tests done in a Medicare-approved lab.
However, if the number of lab tests exceeds the total amount of tests allowed by Medicare, then a person may have some costs.
There might also be some tests that Medicare does not cover. A person can use this online tool to check if their test is covered.
People having a diagnostic test done outside a laboratory setting may face additional costs. For example, if a person has an X-ray in a doctor’s office, the cost will be 20% of the Medicare-approved cost, and they must meet the Medicare Part B annual deductible, which is $240 in 2024.
If the diagnostic nonlaboratory test takes place on an outpatient basis in a hospital, there will often be a copayment.
If a person has a Medicare Advantage plan, there may be copays and coinsurance costs. In addition, a person may have to use their plan’s in-network laboratory.
Medigap or Medicare Advantage plans may not offer additional benefits that include coverage for iron infusions.
However, these plans may help reduce out-of-pocket expenses related to deductibles and copays for iron infusions.
Individual carriers set the terms for these plans, and they may not be available in every state.
Medicaid
Medicaid is a collaborative program between states and the federal government. Medicaid can:
- assist with medical costs for people with limited income and resources
- offer benefits that Medicare does not usually cover, such as personal care services and nursing home care
A person can call their state Medicaid program to see if they are eligible for Medicaid and learn how to apply.
Learn more about eligibility for Medicare and Medicaid.
Medigap
Private insurance companies offer Medicare supplement insurance, or Medigap.
It helps individuals by filling in coverage “gaps,” which are areas of coverage that Original Medicare does not cover, such as coinsurance, copays, and deductibles.
Coverage levels vary among plans.
If a doctor decides that anemia tests, such as a CBC blood test, are medically necessary, Medicare Part B may cover them. A Medicare drug plan (Part D) may help with the cost of prescribed drugs.
Medicare only covers iron infusions under certain circumstances. For iron-deficiency anemia, a person may only qualify if they cannot properly ingest or absorb oral iron supplements.
If a person needs an iron infusion in a hospital following surgery, Medicare Part A can cover it.
Medicaid and Medigap insurance plans may help with costs.