At a minimum, Medicare covers all medically necessary blood tests ordered by your healthcare professional.
Medicare covers many types of blood tests, allowing your healthcare professional to track your health and even screen for disease prevention. Coverage can depend on meeting Medicare-established testing criteria.
Medicare Advantage (Part C) plans may cover more tests than original Medicare (Parts A and B) plans. Under original Medicare, there is no separate fee for blood tests.
A supplemental (Medigap) plan may help with out-of-pocket costs like deductibles.
Medicare Part A offers coverage for medically necessary blood tests. Tests can be ordered by a physician for inpatient hospital, skilled nursing, hospice, home health, and other related covered services.
Medicare Part B covers outpatient blood tests ordered by a physician with a medically necessary diagnosis based on Medicare coverage guidelines. Examples would be screening blood tests to diagnose or manage a condition.
Medicare Advantage, or Part C, plans also cover blood tests. These plans may also cover additional tests not covered by original Medicare (parts A and B).
Each Medicare Advantage plan offers different benefits, so check with your plan about specific blood tests. For maximum benefits, consider going to in-network doctors and labs.
Medicare Part D provides prescription drug coverage and does not cover any blood tests.
Costs are based on the particular test, your location, and the lab used. Tests can run from a few dollars to thousands of dollars. That’s why it’s important to check that your test is covered before you have it done.
Medicare Part A costs
In-hospital blood work ordered by your doctor is generally fully covered under Medicare Part A. However, you still need to meet your deductible.
In 2024, the Part A deductible is $1,632 for most beneficiaries during the benefit period, which lasts from the day you enter the hospital through the next 60 days. Multiple benefit periods can occur in a year.
Medicare Part B costs
Medicare Part B also covers medically necessary outpatient blood tests. You must meet your annual deductible for this coverage, which is $240 for most people in 2024.
Remember, you must also pay your monthly Part B premium, which is $174.70 in 2024 for most beneficiaries.
Medicare Advantage costs
Costs with a Medicare Advantage plan depend on the individual plan coverage. Check with the specific plan in your area about copays, deductibles, and any other out-of-pocket costs.
Some Medicare Advantage plans may offer greater coverage, so you don’t have to pay anything out of pocket.
Medigap costs
Medigap (Medicare supplemental insurance) plans can help pay for out-of-pocket costs, such as coinsurance, deductibles, or copayments for covered screenings and other diagnostic tests.
Each of the 11 available Medigap plans has different benefits and costs, so research these carefully to find the best value for your needs.
TipThere are some situations when blood test costs may be higher than usual, including when:
- You visit providers or labs that don’t accept assignment
- You have a Medicare Advantage plan and choose an out-of-network doctor or lab facility
- Your healthcare professional orders a blood test more often than is covered, or if Medicare does not cover the test
The Medicare website has a search tool to find participating doctors and labs.
You can have blood tests performed at several types of labs. Your healthcare professional will let you know where to get testing done. Just make sure the facility or provider accepts Medicare assignment.
Types of labs covered by Medicare include:
- doctors’ offices
- hospital labs
- independent labs
- nursing facility labs
- other institution labs
If you receive or are asked to sign an Advance Beneficiary Notice (ABN) from the lab or service provider, you may be responsible for the cost of the service because it is not covered.
Ask questions about your responsibility for costs before you sign.
Original Medicare and Medicare Advantage plans cover many types of screening and diagnostic blood tests. However, Medicare may limit the frequency with which it covers certain tests.
You can appeal a coverage decision if you or your doctor believe a test should be covered. Certain screening blood tests, like those for heart disease, are fully covered with no coinsurance or deductibles.
Here are some of the conditions that are commonly screened through blood tests and how often you can have them done with Medicare coverage:
- Diabetes: once a year or up to twice per year if you are at higher risk
- Heart disease: cholesterol, lipids, and triglycerides screening once every 5 years
- HIV: once a year based on risk
- Hepatitis (B and C): once a year, depending on your risk
- Colorectal cancer: once a year
- Prostate-specific antigen (PSA): once a year
- Sexually transmitted infections (STIs): once a year
If your healthcare professional thinks you need more frequent testing due to your specific risk factors, you may have to pay for testing more often. Ask your doctor and the lab for more information about your specific test.
It might be helpful to have a supplemental plan for more frequent testing. The Medicare Medigap policy website has information on all the plans for 2021 and what’s covered. You can also call the plan directly for more information.
Medicare Part B covers many outpatient doctor-ordered tests, such as urinalysis, tissue specimen tests, and screening tests. There are no copays for these tests, but your deductibles still apply.
Examples of covered tests include:
| Condition | Screening | How often |
|---|---|---|
| breast cancer | mammogram | once a year* |
| cervical cancer | pap smear | every 24 months |
| osteoporosis | bone density | every 24 months |
| colon cancer | multitarget stool DNA tests | every 48 months |
| colon cancer | barium enemas | every 48 months |
| colon cancer | flexible sigmoidoscopies | every 48 months |
| colon cancer | colonoscopy | every 24–120 months based on risk |
| colorectal cancer | fecal occult blood test | once every 12 months |
| abdominal aortic aneurysm | abdominal ultrasound | once per lifetime |
| lung cancer | low dose computed tomography (LDCT) | once a year if you meet criteria |
*Medicare covers diagnostic mammograms more often if your doctor orders them. You’re responsible for the 20% coinsurance cost.
Other nonlaboratory diagnostic screenings Medicare covers include:
- X-ray
- PET scan
- MRI
- EKG
- CT scan
You have to pay your 20% coinsurance as well as your deductible and any copays. Remember to go to providers that accept assignment to avoid charges Medicare won’t cover.
Helpful links and tools
- Medicare offers a tool you can use to check which tests are covered.
- You can also review the list of covered tests from Medicare.
- You can look through lists of codes and items Medicare does not cover. Before signing an ABN, ask about the cost of the test and shop around. Prices vary by provider and location.
Medicare covers many types of common blood tests needed to diagnose and manage health conditions as long as they are medically necessary.
Ask your healthcare professional for information on your particular type of blood test and how to prepare.
If you have a condition that requires more frequent testing, consider a supplemental plan like Medigap to help with out-of-pocket costs. If a service is not covered, check around to find the lowest-cost provider.