Does Medicare Cover Iron Infusions?

Iron infusions may alleviate the symptoms of anemia, but Medicare generally only covers this treatment for beneficiaries who have qualifying conditions or meet certain criteria. Learn when Medicare covers iron infusions and who this therapy may be prescribed for.

Does Medicare Cover Iron Infusions?

Medicare covers iron infusions when they’re deemed medically necessary due to a beneficiary’s condition or situation. When determining whether the procedure should be covered, plan administrators may consider underlying diseases and any relevant treatments the individual is undergoing. For example, Medicare commonly covers iron infusions for anemia or iron-deficient individuals in the following circumstances:

• Beneficiaries diagnosed with chronic kidney disease and receiving hemodialysis
• Beneficiaries receiving certain types of chemotherapy
• Beneficiaries who can’t tolerate iron pills taken orally
• Beneficiaries who can’t sufficiently absorb iron from an oral source

Before Medicare authorizes an IV iron treatment, your physician must provide documentation of medical necessity.

How Much Does Medicare Reimburse for Iron Infusions?

Because most iron infusions are done on an outpatient basis, they’re usually covered under Medicare Part B, which reimburses for 80% of the approved treatment after the plan's deductible has been met. The beneficiary is still responsible for any copays or coinsurance.

Beneficiaries who receive an iron infusion during an inpatient stay at a hospital or skilled nursing facility are covered under Part A, Medicare’s hospitalization component. After the deductible is met, Part A may reimburse for up to 100% of covered services. During extended hospital stays, the beneficiary may also be responsible for paying coinsurance.

If you have a Medicare Advantage Plan, your policy's coverage must match or exceed that of Original Medicare. However, specific benefits may vary by state, carrier and individual policy, so contact your plan administrator for more information on specific coverage terms and reimbursement.

Beneficiaries who maintain a Medigap plan may receive additional coverage for the procedure depending on their individual policy.

How Iron Infusions Are Used to Treat Anemia

Without sufficient iron, your body can’t manufacture hemoglobin, which helps red blood cells transport oxygen throughout your body. The resulting condition is known as iron-deficiency anemia.

Anemia may be indicated by the following common symptoms:

• Fatigue
• Headaches
• Weakness or dizziness
• Pale, dry skin
• Frequent bruising
• Rapid heartbeat
• Shortness of breath
• Restless leg syndrome

Anemia is often treated successfully through lifestyle changes or dietary supplements. However, in cases of severe deficiency or when an individual can’t tolerate oral supplements, iron may be delivered intravenously. This is known as an iron infusion or intravenous iron supplementation.

Iron infusion treatments, which deliver iron directly into an individual’s veins through a needle, may use one of these three common iron preparations:

• Iron sucrose: Often sold under the brand name Venofer, iron sucrose is delivered using a slow infusion process that takes between 2 and 5 minutes. When the supplement is mixed with fluid, the infusion may take up to 4 hours.
• Ferric carboxymaltose: Often administered in two doses spaced about a week apart, ferric carboxymaltose may be better known by its brand name, Injectafer.
• Iron dextran: Sold under the brand names Infed and Dexferrum, iron dextran may be administered in large doses after surgeries or to address extreme deficiencies.

The amount of iron administered during an infusion depends on the individual’s height and weight. The number of treatments required to treat the anemia generally depends on the severity of the deficiency and the individual's initial response to the infusion. Individuals should follow their physician's formal treatment plan to obtain the best outcome.

Who Is at Risk for Anemia?

Although anemia can affect anyone, the following groups of people may have a higher risk of developing this condition:

• Infants and children up to age 2
• Women who have heavy periods or fibroids
• Individuals taking blood thinners or regular doses of aspirin
• Seniors with iron-poor diets or chronic conditions such as kidney disease or recurring inflammation

If you fall into one of these risk groups or are experiencing symptoms of anemia, consult your doctor and see if you need testing to properly diagnose the condition. 

How Does a Physician Diagnose Anemia?

Anemia is typically diagnosed through a blood test known as a CBC, or complete blood count, which provides relevant information about the amount, size and shape of your red blood cells. Depending on the type of anemia suspected, your doctor may order additional tests, including a urinalysis, colonoscopy or further blood screenings.

Potential Risks and Side Effects of Iron Infusion Treatments

Although iron infusion therapy may be an effective way of treating anemia, the treatment has risks, including:

• Headaches
• Nausea and vomiting
• Muscle cramps and joint pain
• Temporary changes in the taste of food or drinks
• Itching, swelling or general discomfort at the injection site

In rare cases, individuals may experience more serious events such as an allergic reaction or iron toxicity. To reduce potential risks, your physician may administer a small dose during the first infusion to test for adverse reactions. Your doctor may also monitor your heart rate and blood pressure during and after treatment. If you’re undergoing iron infusion therapy, plan for up to 30 minutes of post-treatment monitoring before being released.

If you experience any discomfort or other adverse effects after leaving the physician’s office or treatment center, let your doctor know immediately.

When Long Does It Take for Iron Infusions to Show Results?

Many individuals begin to feel positive results from iron infusion therapy anywhere between a week to a month after beginning treatment. Let your doctor know if you’re taking any prescription or over-the-counter medications or supplements that may affect the way your body absorbs iron.