Key takeaways:
If you lose a significant amount of blood due to injury, surgery, or a medical condition, you may need a blood transfusion.
Medicare covers blood transfusions but, depending on a number of factors, you may have to pay for the first three units of blood. Typically, you are also charged for blood processing and handling for each unit you receive, whether it’s donated or purchased.
Factors such as having a Medigap supplement insurance plan or getting blood donated specifically for you could reduce your out-of-pocket costs for a transfusion.
A blood transfusion is a routine procedure to replace blood that’s been lost or to replenish critical components like red blood cells, platelets, or plasma. During a transfusion, donated blood or blood products are transferred from a bag into your body via an IV. You may need a transfusion if you lose a lot of blood due to injury, surgery, or a medical condition.
Medicare typically covers blood transfusions for people who have certain conditions or procedures, including:
Bleeding disorders such as hemophilia
Blood cancer
Burns
Serious injuries or accidents, such as a car crash
Surgery that causes blood loss
Search and compare options
For Medicare to cover a blood transfusion, it must be considered medically necessary and be provided at a Medicare-approved facility. Medicare generally doesn’t cover blood transfusion related to plastic surgery, for example. One exception to this is breast reconstruction surgery after a mastectomy to treat breast cancer.
Does Medicare cover blood transfusions?
Yes, original Medicare (Parts A and B) and Medicare Advantage (Part C) plans cover blood transfusions and blood processing and handling. Medicare Part A covers blood transfusions received in a hospital. Medicare Part B covers transfusions received during outpatient treatment.
Your out-of-pocket costs
What you are responsible for paying out of pocket for a blood transfusion depends on whether you have original Medicare or Medicare Advantage.
With original Medicare, if your care facility gets donated blood at no charge, you won’t have to pay for the units or replace them. If the facility has to buy blood for you, you either pay for the first three units of blood or you (or someone else on your behalf) can donate replacement blood.
If you have original Medicare, your out-of-pocket costs for 2024 are:
Medicare Part A: You are responsible for meeting your hospital deductible before your coverage kicks in. In 2024, this is $1,632 per benefit period. Once you meet your deductible, Medicare pays for all of your care, including transfusions, for the first 60 days you are in the hospital.
Medicare Part B: You have to pay a $240 annual deductible. Then, you are responsible for 20% of the Medicare-approved amount for care, including a blood transfusion.
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Medicare Advantage plans are required to match or exceed what original Medicare covers, but the out-of-pocket costs can be different. Some Medicare Advantage plans cover all or part of the cost of the first 3 units of blood in the case of a transfusion. This is also true for some Medicare supplement insurance (Medigap) plans, which are available to people with original Medicare.
How much does a blood transfusion cost?
The cost of a blood transfusion can vary considerably depending on the facility, care team, and procedure. The price of the blood — whether donated or not — as well as processing and handling fees are just the beginning. There are also charges for the transfusion itself.
According to Statista, U.S. hospitals paid $214 for a unit of donated red blood cells, on average, in 2021. The average red blood cell transfusion is three units.
An analysis published in 2023 examined the median amounts charged to consumers in 2021 for blood transfusions at 200 hospitals across the U.S. While the average cost for the hospitals to purchase one unit of red blood cells was about $200, the hospitals charged consumers a median price of $634 per unit. And the median price for a blood transfusion procedure was $2,388, although what individual locations charged varied significantly based on the type of hospital and payer (insurance company or self-pay).
The chart below details the median prices for a red blood cell transfusion at for-profit hospitals and at local government hospitals in 2021, according to the analysis.
Red Blood Cell Transfusion Charges by Facility
Hospital type | Median charge |
For-profit | $2,884 |
Local government | $1,901 |
The analysis also looked at the median transfusion-related charges for various payers in 2021. Medicare, Medicaid, and insurance companies have negotiated prices for blood transfusions.
Red Blood Cell Transfusion Charges by Payer
Payer type | Average charge or negotiated rate |
Cash consumer | $1,388 |
UnitedHealth Group (average negotiated rate) | $1,589 |
Centers for Medicare & Medicaid Services (2021 final rule rate) | $926.59 |
Factors that influence cost
Factors that may affect the cost of a blood transfusion include:
Whether you get have the procedure at a hospital or an outpatient facility
Whether the care team is in your health plan’s network or not
Your blood type
How can you lower your out-of-pocket costs for a blood transfusion with Medicare?
If you’re shopping for a Medicare Advantage plan, compare how various plans cover transfusions to ensure you’ll have lower out-of-pocket costs if you need the procedure. If you stick with original Medicare, you might consider buying a Medigap policy, which could reduce your out-of-pocket costs for a transfusion.
How do Medigap plans help cover the cost of a blood transfusion?
Medigap policies pay for all or part of the cost of three units of blood for transfusion each year. As mentioned, Medigap is supplemental insurance that some original Medicare enrollees purchase to help cover their out-of-pocket costs.
Certain Medigap plans cover all or part of the annual Part A deductible. Only Plans C and F cover the Part B deductible, and these plans are only sold to people who were eligible for Medicare before January 1, 2020. All Medigap plans cover all or part of any copayments or coinsurance you owe from having a transfusion.
What should you do if Medicare won’t cover your blood transfusion?
In most cases, when a transfusion is recommended by a healthcare professional, it’s covered. But if it wasn’t covered and you think it was medically necessary, you can challenge the coverage denial.
You can start by contacting Medicare at 1-800-MEDICARE (1-800–633-4227) or your private insurer if you have Medicare Advantage. Let the representative know you disagree with the coverage decision, and ask about how to file an appeal.
Need an advocate? Organizations like the State Health Insurance Assistance Program (SHIP) may be able to help. SHIP offers free, one-on-one counseling in every state, as well as:
Washington, D.C.
Guam
Puerto Rico
U.S. Virgin Islands
The bottom line
Medicare generally covers blood transfusions that are deemed medically necessary by a healthcare professional. Still, you may have some out-of-pocket expenses. For example, you may have to pay for the first three units of blood — unless you have a Medicare supplement insurance (Medigap) plan that covers the cost or you receive donated blood. Or you may be responsible for a deductible, copayments, or coinsurance.
If you are denied coverage for a transfusion, contact Medicare or your private insurer (if you have Medicare Advantage) to ask about filing an appeal. You can also reach out to your State Health Insurance Assistance Program (SHIP) for free, one-on-one Medicare counseling.
Why trust our experts?
References
American Red Cross. (n.d.). Blood transfusion process.
American Red Cross. (n.d.). Importance of the blood supply.
Elflein, J. (2023). Median amount hospitals in the United States paid per unit of donated blood products in 2021. Statista.
Jacobs, J. W., et al. (2023). United States blood pricing: A cross-sectional analysis of charges and reimbursement at 200 US hospitals. American Journal of Hematology.
Leukemia & Lymphoma Society. (n.d.). Blood transfusion.
Medicare.gov. (n.d.). Blood.
Medicare.gov. (n.d.). Blood processing & handling.
Medicare.gov. (n.d.). Compare Medigap plan benefits.
Medicare.gov. (n.d.). Contact Medicare.
Medicare.gov. (n.d.). How do I file an appeal?
University of Rochester Medical Center. (n.d.). Blood transfusions in adults.
