Does Medicare Cover Iron Infusions?
Iron deficiency can happen for several reasons, and people with certain chronic medical conditions can have a higher risk of developing anemia. Your doctor may prescribe iron infusions to help treat your anemia symptoms. Additionally, Medicare recipients with qualifying conditions or circumstances may be able to have Medicare help pay for their iron infusions.
Medicare Benefits Solutions
Jan 7, 2021
What are iron infusions?
Many times, you can address any iron deficiency you have by making lifestyle changes or dietary supplements. If you have an extreme deficiency, you may need an iron infusion, and there are three common types.
- Ferric Carboxymaltose – You’ll get two doses of this product spaced seven days apart. Injectafer is the brand name for this solution.
- Iron Dextran –In extreme situations or after certain surgeries, your doctor can administer this in large doses. It’s marketed under Infed and Dexferrum for brand names.
- Iron Sucrose – Iron sucrose is an iron replacement product that you get over a two to five-minute infusion by itself. If your doctor mixes it with another fluid, it can run from 15 minutes to 4 hours. Venofer is one common brand name.
Your doctor will take your weight and height and figure out the correct dosage of iron infusions to treat your anemia. How many treatments you get will depend on how well you respond to the first one. This plan’s success relies heavily on how well you keep to the schedule your doctor sets for you.
Iron infusion side effects
At the injection site, you can experience swelling, itching, or discomfort. A few patients report that their drink or food tastes change for a short period, and other people reported experiencing cramps, headaches, vomiting, or nausea.
Your doctor may keep a close eye on your blood pressure and your heart rate before the infusion, during it, and after it. Monitoring could stretch up to 30 minutes each time, and allergic reactions or iron toxicity are rare side effects your doctor watches for. The first dose you get is small, and your doctor will use it to check for an allergic reaction.
Iron infusions and Medicare coverage
Most iron infusions are done in an outpatient setting. This means that Medicare Part B under Original Medicare can help with 80% of the Medicare-approved cost if the doctor and facility accept Medicare assignment. Your copay, coinsurance, and any relevant deductibles can increase how much you pay. If you need an iron infusion as a result of surgery while you’re staying as an inpatient at a hospital, Part A will help cover the costs.
Medicare will look at how medically necessary an iron infusion is for your condition when it determines if it’ll pay for it. Most commonly, people who are on hemodialysis get iron infusions because they have chronic kidney disease. Medicare recipients who are getting specific types of chemotherapy may qualify for iron infusions too.
Any recipient who is deficient in iron and can’t take iron pills orally or who is unable to sufficiently absorb iron from and the oral source could get coverage under Part B for the infusions. Your primary care physician will have to provide documentation and proof that you need the infusion for Medicare to authorize you to have it.
Medicare Advantage plans will have the same benefits as Original Medicare, but many have additional benefits. MA plans may help to reduce your out-of-pocket costs when it comes to the copays and deductibles that come with this treatment. Private insurers manage these plans, so plans can differ in coverage and costs. It’s a good idea to talk to your specific plan to see whether or not they offer coverage for iron infusions.
The cost per infusion will depend on your location, the setting, and the drug. The most expensive infusion drug for iron can cost over $3,000 per visit. Venofer is around $835 per visit, while Infed is $1,500. Ferrlecit runs roughly $400 per visit, so it can add up quickly if you don’t have coverage.