Does Medicare Pay for Blood Transfusions?
Demystify Medicare's coverage for blood transfusions. Learn the conditions and cost-sharing details across various Medicare plans.
Medically necessary blood transfusions are generally covered by Medicare, but specific coverage and costs depend on the setting and type of Medicare plan. This article clarifies how Medicare addresses the costs of blood transfusions across different settings and plan types.
Coverage for Inpatient Transfusions
Medicare Part A, Hospital Insurance, covers medically necessary blood transfusions when received as part of a covered inpatient hospital stay. This coverage applies when a patient is formally admitted to a hospital for a related condition that necessitates the transfusion. For 2025, the Part A inpatient hospital deductible is $1,676 per benefit period, which an individual must pay before Medicare begins to cover costs.
After the deductible is met, Medicare Part A covers the full cost of inpatient hospital care for the first 60 days of a benefit period. For longer stays, a daily coinsurance applies; specifically, from day 61 through day 90, the coinsurance is $419 per day in 2025. If a hospital stay extends beyond 90 days, beneficiaries utilize lifetime reserve days, incurring a coinsurance of $838 per day for up to 60 lifetime reserve days.
The “first three units” rule applies to blood transfusions under Part A. If the hospital or provider purchases the blood, the beneficiary is responsible for the cost of the first three units of blood received in a calendar year. After these initial three units, Medicare covers the cost of any additional units needed for the remainder of that year. However, if the blood is acquired by the facility at no charge, such as through a blood bank donation, the beneficiary does not pay for those specific units.
Coverage for Outpatient Transfusions
Medicare Part B, Medical Insurance (Part B), covers medically necessary blood transfusions received in outpatient settings. This includes transfusions administered in a doctor’s office, an outpatient clinic, or an emergency room if the patient is not admitted to the hospital. Part B beneficiaries are responsible for an annual deductible, which is $257 for 2025. Once this deductible is satisfied, individuals typically pay a 20% coinsurance of the Medicare-approved amount for most Part B-covered services, including blood transfusions.
Similar to Part A, the “first three units” rule also applies to outpatient blood transfusions under Part B. A copayment may also be charged for the processing and handling services of donated blood in outpatient settings.
Medicare Advantage and Supplemental Coverage
Medicare Advantage (Part C) plans are offered by private companies and are an alternative to Original Medicare (Parts A and B). These plans are required to cover the same services as Original Medicare, including medically necessary blood transfusions. While the scope of coverage is similar, Medicare Advantage plans often have different cost-sharing structures, such as varying copayments, coinsurance, and deductibles, that apply to transfusions.
Medicare Advantage plans may also have specific network restrictions or prior authorization requirements. The out-of-pocket maximum for Medicare Advantage plans in 2025 is $9,350 for in-network services, and potentially higher for out-of-network care, providing a limit on annual expenses.
Medicare Supplement (Medigap) policies are private insurance plans that work with Original Medicare to help pay for some of the out-of-pocket costs that Original Medicare does not cover. These policies can help cover expenses such as deductibles, copayments, and coinsurance associated with blood transfusions under Parts A and B. Medigap policies only supplement Original Medicare and cannot be used in conjunction with Medicare Advantage plans. Most Medigap plans provide coverage for the cost of blood transfusions, including the copayment for collection, storage, handling, and infusion charges per unit of blood. Some Medigap plans may also cover the “first three units” of blood that Original Medicare does not. The specific benefits vary by plan type, identified by letters (e.g., Plan G, Plan N), and are standardized, meaning a Plan G from one insurer offers the same benefits as a Plan G from another.