Can you imagine a doctor postponing surgery because YOU forgot to bring scrubs? It sounds like a weird dream. It’s your doctor’s responsibility to stock the operating table.
As a Medicare beneficiary, though, there’s a medical charge that might surprise you: the Medicare blood deductible. Under Medicare, you actually have to pay for (or donate) the first three pints of blood you use each calendar year.
“It usually catches people off guard,” according to Laurel Stauffer-Daly, ChFC (Chartered Financial Consultant). “I fondly call it the ‘vampire deductible’.”
How to Avoid Paying the Medicare Blood Deductible
Instead of seeing red over this random cost, there are several ways that you can take care of this seemingly priceless benefit.
To avoid paying the Medicare blood deductible, you can:
- Purchase a Medicare Supplement (“Medigap”) plan;
- Medigap plans cover either part or all of the cost for all three pints.
- Enroll in certain Medicare Advantage (Medicare Part C) plans;
- Part C plans must be equal to or better than Original Medicare coverage. Most Medicare Advantage plans cover all three pints to avoid the hassle of billing for blood.
- Or Arrange for Donated Blood (This Is Free).
- You can actually donate your own blood, before or after a procedure, once you’re healthy.
- You can have someone else donate blood in your name.
- You can ask a blood bank to donate blood directly to your health provider.
- Hospitals may even use donated blood in a procedure without asking you.
Medicare Blood Deductible Under Part A and Part B
The “vampire deductible” is separate from your regular Medicare Part A deductible, a flat amount charged upon admission to the hospital. Medicare Part A covers blood you get while in the hospital,1 while Part B covers blood you get as an outpatient. But the deductible applies to Parts A and B combined.2 Medicare Part B may also charge you a copayment for blood handling and processing.
When Will You Need a Blood Transfusion?
Medicare beneficiaries usually need a blood transfusion at some point, so the cost of a blood transfusion is important to know.
Most adults have in their bodies between 10 to 12 pints of blood at any time, so three pints of blood may seem like a lot. However, you could find yourself owing blood money very quickly, or every year. Surgeries that require blood may use a great deal of it to keep you healthy.
These are the cases for which blood transfusions happen regularly:
- During surgical procedures, you’re almost certainly going to need blood on hand, whether or not it’s used.
- If you develop cancer of the blood, you’ll need a blood transfusion as part of your treatment.
- If you’re involved in a traumatic accident, you may need a great deal of blood.
- Certain genetic disorders will also require regular blood donations.
There are many medical procedures that range from routine to very serious where you’ll be grateful for having blood available.
Exceptions to the Medicare Blood Deductible
It’s important to know that other blood products are not charged under Medicare. Only whole, complete blood or packages of concentrated red cells are subject to the vampire deductible. Platelets, plasma, gamma globin, and other products that come from processing blood are not subject to the vampire deductible.
You also won’t be charged for unused blood that was stocked for your medical procedure. Unused blood will likely be measured by the pint, not the cell.
How Much Will Three Pints of Blood Cost?
Blood prices are different wherever you go, but you can expect to pay anywhere from $400 to $1,200 for three pints. “Most providers don’t list what they charge,” according to Stauffer-Daly.
After you’ve used three pints of blood, your Medicare Part A deductible will still apply if you’re in inpatient care ($1,408 per benefit period in 2020). Additional Part A costs are a little bit more complicated, and you can read about them here. Considering the growth of same-day surgery, it’s also quite possible that you’ll use blood in an outpatient setting. In that case, Medicare Part B will handle your costs for subsequent pints of blood.
Medicare Supplement (“Medigap”)
All Medicare Supplement plan types cover blood transfusions. Remember, each plan type (like Medicare Plan F) has the same benefits, no matter which company you buy it from. Plans K and L only provide partial coverage until you reach your out-of-pocket maximum, as per their rules for all treatment.
Medicare Advantage plans set their own rules for coverage; however, your Medicare Advantage coverage will be at least as comprehensive as Original Medicare. Medicare Advantage plans have an out-of-pocket maximum of, at most, $6,700 in 2020.
PSA: Where to Donate Blood
Natural disasters create blood shortages, affecting patients across the healthcare system. Unfortunately, blood isn’t just expensive because it’s scarce. Blood is also hard to store. Red blood cells are only viable for 42 days, and individuals generally can’t donate that frequently.
Blood banks also make use of more than just red blood cells. Platelets expire after just 5 days and can be donated up to 24 times per year. Platelet donations are particularly important for chemotherapy patients, who rely on donated blood to survive. The following organizations can restock blood that you’ve used, or help others in need:
- American Association of Blood Banks: The national advocacy group for blood banks, AABB maintains a list of blood donation centers.
- America’s Blood Centers: The country’s largest network of community-based and independent blood centers, the ABC has a location finder on their website.
- American Red Cross: The Red Cross organizes humanitarian work and disaster relief in addition to maintaining blood banks. You can call 1-800-RED-CROSS or visit the location finder on their website to donate.
Taking the Next Steps
See if Medigap coverage makes sense for your needs. If you expect to get a blood transfusion, a Medicare Supplement plan can help offset the costs of the Medicare blood deductible. But you need to keep your needs in mind when you’re first eligible for Medicare. In most states, after that initial six-month Medigap enrollment window closes, you’ll have to go through medical underwriting, which means your eligibility to enroll will be based on your medical history. If you’re going to need a blood transfusion, it could make the underwriting process more difficult.