Blood has a number of important functions that include supplying your cells with oxygen and nutrients, fighting off infection, and removing waste such as carbon dioxide and lactic acid.
Hematologic diseases or blood disorders can impact your blood’s ability to function like it should. As you age, common blood disorders such as anemia and blood cancers may become more likely.
If you are age 65 and older, have ALS or ESRD, or have been receiving Social Security Disability Income for at least 25 months, you may be eligible for Medicare insurance. Medicare may cover some treatments and testing for common blood disorders.
List of Common Blood Disorders in the Elderly
As you age, you may become more susceptible to blood disorders. Common blood disorders in the elderly range from conditions that can be treated with diet and supplements to chronic diseases. The most common blood disorders include:
- Blood clots
Medicare Chronic Special Needs Plans for Blood Disorders
Original Medicare (Part A and Part B) may cover certain medical services for blood disorders. Medicare Part A is hospital insurance, and it can cover inpatient services such as surgeries that take place in the hospital. Medicare Part B is medical insurance, and it can cover outpatient services such as doctor visits and treatment, and emergency transportation.
Medicare Advantage plans are private health insurance plans that can offer supplemental benefits that Original Medicare does not such as prescription drug coverage, non-emergency medical transportation, and meal delivery.
Some chronic blood diseases may qualify you for a special type of Medicare Advantage plan called a Chronic Special Needs Plan (CSNP).
If you’re eligible for a CSNP, you may also qualify for a Special Enrollment Period (SEP) that allows you to make changes to your coverage as your medical needs change. Most people on Medicare have to wait for certain times of year to make changes.
With many CSNPs, you get coordination of care between multiple providers to ensure that your medical needs are met.. For example, a CSNP for leukemia, a type of blood cancer, may help pay for treatment by a blood specialist called a hematologist and/or a cancer specialist called an oncologist. Other team members may include surgeons and oncology nurses.
Another coverage option is a Medicare Supplement (Medigap) plan. Medigap plans can help cover certain fees associated with Original Medicare such as Part A and Part B coinsurance and copays, but they don’t usually include additional health benefits.
You cannot have both Medicare Advantage and Medicare Supplements. A licensed insurance agent can be an important resource for deciding which type of plan would best suit your needs.
Anemia in the Elderly
Anemia is a condition that happens when you have a lack of healthy red blood cells or a lack of hemoglobin (a main component of red blood cells). It can be caused by blood loss, decreased red blood cell production, and/or destruction of red blood cells. Symptoms include:
- Fast or unusual heartbeat
- Pain in your bones, chest, belly, and/or joints
- Shortness of breath
- Pale or yellow skin
- Swollen or cold hands and feet
- Feeling tired or weak
- Vision problems
Medicare Coverage for Anemia
Medicare may cover a specific type of screening called a blood count for anemia if your doctor recommends one. The blood count can determine how much hemoglobin, white blood cells, and platelets your body has.
Medicare coverage for anemia treatment depends on the treatment. For example, a vitamin B12 deficiency can cause certain types of anemia, and they can be treated with oral vitamins and supplements. Neither Original Medicare nor Medicare Part D covers over-the-counter (OTC) vitamin supplements, however, some Medicare Advantage plans have an OTC benefit.
Original Medicare will help pay for vitamin B12 injections for certain types of anemia, as long as the injections are “reasonable and necessary to the treatment” of your hematologic disorder.
If your anemia is due to an iron deficiency, your doctor may recommend OTC supplements and/or changes to your diet.
If your body can’t produce enough red blood cells, your doctor may recommend blood transfusions as part of your anemia treatment. In that case, Medicare may help cover blood transfusions. You may have to pay coinsurance, copays, or deductibles depending on your plan and how your healthcare facility gets the blood.
Sometimes underlying chronic diseases such as cancer, kidney disease, and HIV/AIDS can cause anemia. In those cases, your treatment will depend on your condition and what your doctor recommends.
The most common types of blood cancer include leukemia, lymphoma, and myeloma.
- Fever or chills
- Persistent fatigue, weakness
- Frequent or severe infections
- Losing weight without trying
- Swollen lymph nodes, enlarged liver or spleen
- Bleeding or bruising easily
- Frequent nosebleeds
- Tiny red spots on your skin
- Excessive sweating, especially at night
- Pain in your bones
According to the Mayo Clinic, lymphoma is a blood cancer that occurs in the lymphatic system — part of the body’s “germ-fighting network.” Lymphoma has two main subtypes, which are Hodgkin’s and non-Hodgkin’s. Symptoms include:
- Painless swelling of the lymph nodes in your neck, armpits, or groin
- Chronic fatigue
- Night sweats
- Shortness of breath
- Unintentional weight loss
- Itchy skin
Myeloma is a cancer that forms in a type of white blood cell called a plasma cell. Your plasma cells help fight infection by making antibodies that attack germs. The cancer forms in your bone marrow, where the cancer cells can eventually outnumber healthy plasma cells. When that happens, your plasma cells can no longer produce antibodies. The cancer cells begin to produce proteins that can cause serious complications. Symptoms include:
- Bone pain, especially in your spine or chest
- Loss of appetite
- Mental fogginess or confusion
- Frequent infections
- Unexplained weight loss
- Weakness or numbness in your legs
- Excessive thirst
Medicare Coverage for Blood Cancer
Your healthcare providers will create and execute your treatment plan depending on your type of blood cancer.
Medicare may cover diagnostic testing and screenings or blood cancer. Part B may cover treatments including outpatient radiation and intravenous chemotherapy. Medicare Part B may also cover CAR T-cell therapy for leukemia and lymphoma. Part A may cover hospital stays and inpatient surgeries as well as limited home healthcare services and skilled nursing care.
Medicare Part D may cover oral chemotherapy medications, painkillers, and/or anti-nausea drugs.
If you have blood cancer, you may qualify for a CSNP. After your initial diagnosis, you have 30 days to enroll in new coverage. If you need help selecting a CSNP*, talk to your agent. If you have a CSNP, your SEP will allow you to change your coverage as you need to. Your agent may be a valuable resource for finding the right plans.
*CSNPs may not be available in every location.
Hemophilia is a hematologic disorder in which the blood can’t easily clot. If you have hemophilia, even a slight injury can cause severe bleeding. According to the Centers for Disease Control and Prevention (CDC), hemophilia is caused by a mutation in the gene that provides clotting instructions. The mutation can stop the “clotting protein from working properly.” Hemophilia can result in:
- Bleeding in the joints that can lead to joint pain and disease
- Bleeding in the brain which can cause long-term issues including paralysis and seizures
- Bleeding in vital organs which can lead to death if the issue is severe
Medicare Coverage for Hemophilia
According to the National Hemophilia Foundation, Medicare Part B helps cover “clotting factors,” which are concentrated forms of clotting proteins. The CDC separates clotting factor products into two groups: plasma-derived and recombinant. Plasma-derived products come from donors. The clotting factors are separated from the blood plasma, tested for viruses, and freeze-dried. Recombinant products are genetically engineered in a laboratory. They do not contain any plasma or albumin.
If you get a cut or scrape, blood cells called platelets and certain clotting proteins in your plasma work together to create clot over the injury. Usually, your body will dissolve the blood clot after you’ve healed. According to the American Society of Hematology, sometimes clots do not dissolve naturally, or they form on the inside of blood vessels without an injury.
Blood clots may be extremely dangerous. For example, blood clots in the brain can lead to a stroke, clots in the coronary artery can cause a heart attack, and clots in the pulmonary artery can cause pulmonary embolisms.
According to Medical News Today, the legs are the most common place for a blood clot to develop. Symptoms of a clot in the leg may include:
- A feeling of warmth
- Pain in your calf when you stretch your toes upward
Medicare Coverage for Blood Clots
Medicare covers medically necessary diagnostic tests such as pulmonary angiograms or ultrasounds to look for blood clots.
Treatment for blood clots may include prescription anticoagulants (blood thinners). Medicare Part D or certain Medicare Advantage plans may cover blood thinners such as Xarelto.
Get Coverage for Common Blood Disorders Today
If you need coverage for the most common blood disorders in the elderly, a licensed agent with Medicare Plan Finder may be able to help. Our agents can see what plans are available in your area and help you decide which one works best for your needs, whether you need a CSNP, Medicare Advantage plan, or a Medicare Part D plan. To arrange a meeting with an agent, call 1-844-431-1832 or contact us here now.