How Medicare Covers B12 Shots

Does Medicare Cover B12 Shots? 

Yes, Medicare will cover B12 shots that a doctor certifies as medically necessary in treating a nutrient deficiency. Most people derive their daily allotment of vitamin B12 from poultry, fish, meat, eggs, and “fortified” foods like nutritional yeast and certain breakfast cereals. However, individuals who do not consume animal products or take over-the-counter B12 supplements can experience lethargy, depression, and other symptoms indicative of a deficiency.

If lab tests show you have B12 levels below 200pg/ml, your physician may write a medically necessary prescription for regular B12 injections. Depending on the nature of your condition, Medicare Part A, Part B, Medicare Advantage, and Medigap can all help cover varying aspects of treatment.

The Importance of Vitamin B12 

Vitamin B12 moderates the body’s blood and nerve cells, regenerates DNA, and helps prevent pernicious anemia, a blood disorder that makes people weak and tired. Common symptoms of a B12 deficiency include:

• Lethargy
• Pale skin
• Heart palpitations
• Loss of appetite
• Trouble remembering
• Weight loss
• Depression
• Poor balance
• Tingling nerves
• Infertility

If you have struggled with any of these symptoms over a prolonged period, schedule an appointment with your doctor for an exam and laboratory test. Most adults need at least 2.4 micrograms of B12 daily. Because the stomach acid levels necessary to absorb certain nutrients decline with age, understanding Medicare guidelines for B12 injections can help you save money and remain healthy.

Understanding Medicare Coverage for B12 Shots 

To ensure coverage through Medicare, you must have applicable benefits and a doctor’s prescription verifying vitamin B12 injections as medically necessary.

Eligibility 

Medicare is a federally regulated health insurance program for US citizens over 65 and some younger individuals with qualifying disabilities. You must meet the following eligibility requirements for Medicare to cover B12 injections: 

• Usually, you must display apparent symptoms of a B12 deficiency and receive a blood test proving your diagnosis.
• Your doctor must diagnose you with a nutrient shortage.
• Your doctor must write a medically necessary prescription for treatment.

Part A Coverage 

Medicare Part A (Hospital Insurance) pays for inpatient care and supplies in hospitals, emergency rooms, and skilled nursing facilities, as well as costs associated with hospice and home healthcare. Therefore, Part A will only cover B12 shots ordered by doctors and medical staff for patients actively rehabilitating in any of these environments. 

Part B Coverage 

Medicare Part B (Medical Insurance) covers outpatient doctor services, preventative care exams, lab tests, and durable medical equipment like crutches and wheelchairs. If your primary care physician prescribes vitamin B-12 injections and blood tests as medically necessary in treating or diagnosing a nutrient deficiency, Part B will help pay for it.

Part D Coverage 

People enrolled in both Medicare Part A and Part B can purchase supplementary prescription drug coverage, or Medicare Part D, through private insurance companies approved by Medicare. Because these plans never include benefits for vitamins, minerals, or supplements, Part D will never pay for B12 shots, even those prescribed as medically necessary by a doctor.

Medigap Coverage 

Private insurers also sell various Medicare Supplement Insurance, or Medigap, plans to help beneficiaries fill “gaps” in their Original Medicare coverage. While Medigap will never directly pay for B12 shots, most policies will help absorb standard out-of-pocket expenses like deductibles and coinsurance. You must have both Medicare Part A and Part B to enroll in Medigap.

How Does Medicare Advantage Cover B12 Shots? 

Unlike federally-funded Original Medicare, which comes standardized for all beneficiaries, private companies often structure their Medicare Advantage Plans according to unique guidelines. While Medicare Advantage must provide minimum equivalent coverage to Original Medicare, many compliant policies incorporate additional benefits like dental care, prescription drugs, and over-the-counter supplies. 

Therefore, all Medicare Advantage Plans will cover medically necessary B12 shots ordered by a doctor. Some policies may even help pay for vitamin supplements and prescribed injections without requiring a certificate of medical necessity.

How Much Do B12 Shots Cost With Medicare? 

B12 shots can cost anywhere from $30 to $80 per dosage. Notably, this does not include applicable doctor, nurse, or specialist fees. 

If you have a B12 deficiency that has not improved through dietary changes or OTC supplements, you may need these injections every 2-3 months for the rest of your life. Without insurance, out-of-pocket treatment costs could quickly stack up to hundreds of dollars every year.

Part A Costs 

Most people who have paid their fair share of Social Security taxes will automatically receive premium-free Medicare Part A on their 65th birthday. After they meet their annual $1,632 deductible, Part A will cover 100% of any B12 shots administered during the first 60 days a patient spends at a hospital, skilled nursing facility, or other eligible inpatient environment. All care received after the 60th consecutive day will require a significant copayment.

Part B Costs 

Unlike Medicare Part A, all eligible seniors must pay a $174.70 monthly premium to retain Part B coverage. Part B will absorb 80% of the cost of all medically necessary vitamin B12 shots ordered by a patient’s primary care physician, leaving these individuals to reimburse the remaining 20% coinsurance and their annual $240 deductible out of pocket.

Medicare Advantage Costs 

Despite mandated coverage requirements, the private companies that sell Medicare Advantage can set varying premiums, deductibles, copayments, and coinsurance rates. Therefore, your share of costs for a B12 injection covered by Medicare Advantage will depend on your insurer and selected policy. 

All Medicare Advantage Plans cap patient out-of-pocket spending at a maximum of $8,850 annually. If you exceed this limit, you will owe nothing on B12 shots for the remainder of the year.

Alternatives to Medicare-Covered B12 Shots 

If your doctor does not prescribe B12 shots as medically necessary, try increasing your daily intake of meat, fish, dairy, eggs, and other animal products. If you adhere to a vegetarian or vegan diet, you can still get B12 through fortified foods such as:

• Nutritional yeast
• Tofu
• Fruit juice
• Specific breakfast cereals

You can also boost your B12 levels by ingesting over-the-counter capsules, helping prevent anemia, nerve issues, and dementia.

In rare cases, B12 overuse can cause minor symptoms like nausea, headaches, and dizziness. While most excess vitamin B passes safely through the urine, always consult a doctor before purchasing supplements to know your precise dosage and how long to continue treatment. 

All in All 

All people require a variety of nutrients and minerals to stay healthy. Specifically, vitamin B12 helps moderate our blood and nerve cells and prevents gastrointestinal disorders, pernicious anemia, dementia, nerve issues, and other problems that typically worsen with age. If you cannot correct a B12 deficiency through dietary changes or OTC supplements, your doctor may prescribe regular injections. 

While Medicare will cover medically necessary B12 shots under most circumstances, call 1-800-MEDICARE or your private Medicare Advantage insurer to guarantee a total understanding of your benefits and cost-sharing responsibilities.