Some parts of Medicare cover medically necessary clinical diagnostic lab services, while other programs may help with costs.
Anemia is a health condition that occurs when blood does not carry enough oxygen from the lungs to the rest of the body.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
The main causes of anemia include:
- blood loss
- lack of red blood cell production
- a high rate of red blood cell destruction
The most common cause of anemia is an insufficient amount of iron, which the human body needs to make hemoglobin. Hemoglobin is an iron-rich protein needed to move oxygen from the lungs to the rest of the body.
Health conditions that may lead to anemia include:
- a blood disorder such as cancer, sickle cell anemia, and thalassemia
- a diet without enough iron, folic acid, or vitamin B12
- aplastic anemia
- colon cancer
- colon polyps
- g6pd deficiency (a metabolic disorder)
- inherited disorders
- unusually heavy periods
Anemia can make a person feel cold, tired, dizzy, and irritable. They may also have a headache or experience shortness of breath.
When making a diagnosis, a doctor may look at a person’s medical history, do a physical exam, and order a complete blood count (CBC) test to detect anemia. The doctor may also use a CBC test to evaluate a person’s overall health.
The recommended treatment will depend on the type of anemia. Recommendations may include:
- an iron supplement (prescription or over-the-counter)
- a certain type of vitamin
- intravenous iron therapy
- prescription medicine to help the body produce more red blood cells
- for severe cases, red blood cell transfusions
The doctor may also suggest a change in diet to prevent future health problems.
Federally funded Medicare provides health insurance for individuals age 65 or older and some younger people with certain conditions or diseases.
The program includes:
- Part A for hospital insurance
- Part B offers medical insurance
- Part C, or Medicare Advantage, is an alternative to original Medicare (Part A and Part B)
- Part D provides coverage for prescription drugs
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
- 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.
Medicare Part D offers coverage for prescription drugs, such as vitamins, iron, or folic acid supplements.
In general, a person has no 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.
However, there might 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 of $203.
If the diagnostic non-laboratory test takes place on an outpatient basis in a hospital, there will 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.
There are some programs that may help with costs.
Medicaid is a collaborative program between states and the federal government. Medicaid can:
- assist with medical costs for people with limited income and resources
- may 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.
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.
Anemia is a health condition that happens when the blood does not carry enough oxygen throughout the body. The usual cause of anemia is an iron deficiency. A doctor may recommend a complete blood count (CBC) test to detect anemia.
Medicare Part B covers some medically necessary clinical diagnostic lab services, including a CBC blood test. A Medicare drug plan (Part D) may help with the cost of prescribed drugs.
Medicaid and Medigap insurance plans may help with costs.