Does Your Medicare Plan Cover B12 Shots?
Fair Square Medicare

Does Your Medicare Plan Cover B12 Shots?

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By Daniel Petkevich

Aug 15, 2022

If You Need B12 Shots, Does Medicare Cover Them?

Aging can be beautiful, but it comes with its fair share of surprises.

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As we age, our bodies can become deficient in key vitamins and minerals because we don't absorb them as efficiently as when we were young.

A common example of this is B12 deficiency. B12 shots can help you be healthier by adding more vitamins to your body. If you have Medicare, do you have to pay for B12 shots?

Let's take a look at B12 shots and whether Medicare will cover your expenses.

What's a B12 Shot?

A B12 shot is an injection for Vitamin B12 deficiency.

Vitamin B12 is water-soluble and is naturally found in some foods, such as meat, fish, and dairy products. It's essential for:

  • Brain and nerve cells

  • Production of DNA

  • Production of red blood cells

Without enough Vitamin B12, it's not uncommon to experience anemia, chronic fatigue, mouth ulcers, depression, or memory loss — along with many other symptoms.

Vitamin B12 Deficiency

Vitamin B12 deficiency affects more than 20% of the elderly population.

If you have B12 deficiency, your doctor may suggest that you eat Vitamin B12-rich foods. Something else they might suggest are B12 shots. These are a quicker way to replenish your B12 levels, especially if you have difficulty absorbing Vitamin B12 from food.

Does Medicare Cover B12 Shots?

Let's look at the situations where Medicare will cover your B12 shots. Keep in mind that even if you do get Medicare coverage for your B12 shots, you might still have deductibles, coinsurance, or copayments.

Medicare Parts A and B

If you’re admitted to a hospital, a skilled nursing facility, or a hospice care facility — and your doctor orders a B12 shot as a treatment procedure — Medicare Part A may cover your expenses.

For example, if you're in the hospital and your doctor orders medically necessary B12 shots to treat anemia, a gastrointestinal disorder, neuropathy, or some other health issue caused by B12 deficiency, Medicare Part A may provide coverage.

In most cases, you'll receive a B12 shot in an outpatient setting. If your doctor recommends a B12 shot during an outpatient visit, Medicare Part B may cover your expenses. (Part B typically covers drugs that need to be administered by a medical professional).

Even if Medicare Part B approves your B12 shots, you may still owe a copay. This is determined by the type of Medicare plan that you're on.

Still, if you have Medicare Part B coverage, verify what you'll owe your healthcare provider before scheduling an appointment. We can help you do this.

Medicare Part D

Medicare Part D covers a wide range of prescription drugs. But, it doesn't cover over-the-counter drugs, vitamins, minerals, or supplements.

Part D plans are required to list all prescription drugs they cover in a formulary. Formularies can vary from one Medicare Part D plan to another.

If your Medicare Part D plan lists B12 shots in their formulary, you'll get coverage.

But if B12 shots aren't listed in your plan's formulary, don't worry just yet. You might still be able to get coverage by requesting a utilization management review.

This program evaluates the efficiency and necessity of the treatments you're seeking. If your plan provider considers the treatment a medical necessity based on your doctor's recommendation, you could receive your B12 shots at a much lower cost — or even for free.

Medicare Advantage Plans

Medicare Advantage plans, also known as Medicare Part C, are health insurance plans offered by private insurance companies. They cover the same benefits as Original Medicare — Part A and Part B — but they can also provide additional coverage for providers' visits and treatments like prescription drugs.

Just like Medicare Part D, Medicare Advantage plans have a formulary of drugs they'll cover. If your Medicare Advantage plan includes prescription drugs and B12 shots in its drug formulary, you may get coverage. Check with your plan provider to find out if they cover B12 shots.

How Much Does a B12 Shot Cost?

The cost of a B12 shot depends on how it's administered. Self-administered B12 shots generally cost less than shots given by a doctor or clinic.

The type of B12 shot also affects the cost. Synthetic B12 shots, which use a form of vitamin B12 not found in nature, are typically less expensive than natural B12 shots.

If your insurance plan doesn't cover B12 shots, you could pay anywhere from $10 to $75 per shot. Medicare can potentially help you get these treatments at little to no cost.

Conclusion

The human body needs Vitamin B12 to function normally. If your vitamin deficiency is caused by malabsorption of B12 from food, your doctor might recommend B12 shots.

If your provider recommends them, Medicare may cover B12 shots for you. Check with your insurance provider if you're unsure whether your plan provides coverage for B12 shots.

You can also call us at (888)-376-2028. Our team of experts is happy to check your plan's coverage and answer any other Medicare-related questions you have.

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Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.


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