- Medicare covers medically necessary blood tests ordered by a physician based on Medicare guidelines.
- Medicare Advantage (Part C) plans may cover more tests, depending on the plan.
- There is no separate fee for blood tests under original Medicare.
- A supplemental (Medigap) plan may help with out-of-pocket costs like deductibles.
Blood tests are an important diagnostic tool doctors use to screen for risk factors and monitor health conditions. It is generally a simple procedure to measure how your body is functioning and find any early warning signs.
Medicare covers many types of
Let’s look at which parts of Medicare cover blood tests and other diagnostic tests.
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. Also consider going to in-network doctors and labs to get the maximum benefits.
Medicare Part D provides prescription drug coverage and does not cover any blood tests.
Costs of blood tests and other lab screening or diagnostic tests can vary. The 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.
Here are some of the blood test costs you can expect with the different parts of Medicare.
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 2020, the Part A deductible is $1,408 for most beneficiaries during the benefit period. The benefit period lasts from the day you enter the hospital through the next 60 days. It is possible to have multiple benefit periods in a year.
Medicare Part B costs
Medicare Part B also covers medically necessary outpatient blood tests. You have to meet your annual deductible for this coverage as well. In 2020, the deductible is $198 for most people. Remember, you also have to pay your monthly Part B premium, which is $144.60 in 2020 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 also offer greater coverage, so you don’t have to pay anything out of pocket.
Medigap (Medicare supplemental insurance) plans can help pay for some out-of-pocket costs like coinsurance, deductibles, or copayments of covered screenings and other diagnostic tests.
Each of the 11 available Medigap plans have different benefits and costs, so research these carefully to find the best value for your needs.
There 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 doctor orders a blood test more often than is covered or if the test is not covered by Medicare (certain screening tests are not covered if there are no signs or symptoms of disease or there is no history)
The Medicare website has a search tool you can use to find participating doctors and labs.
You can have blood tests performed at several types of labs. Your doctor will let you know where to get testing done. Just make sure the facility or provider accepts 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. There may be limits on how frequently Medicare will cover certain tests.
You can appeal a coverage decision if you or your doctor feels a test should be covered. Certain screening blood tests, like those for heart disease, are fully covered with no coinsurance or deductibles.
examples of covered blood tests
Here are some of the conditions that are commonly tested 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 higher risk
- Heart disease: cholesterol, lipids, triglycerides screening once every 5 years
- HIV: once a year based on risk
- Hepatitis (B and C): once a year depending on risk
- Colorectal cancer: once a year
- Prostate cancer (PSA [prostate specific antigen] test): once a year
- Sexually transmitted diseases: once a year
If your doctor thinks you need more frequent testing for certain diagnostic tests 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. You can go to the Medicare Medigap policy website for information on all the plans for 2020 and what’s covered. You can also call the plan directly for more information.
Medicare Part B covers many types of outpatient doctor-ordered tests like urinalysis, tissue specimen tests, and screening tests. There are no copays for these tests, but your deductibles still apply.
Examples of covered tests include:
|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 are responsible for the 20 percent coinsurance cost.
Other nonlaboratory diagnostic screenings Medicare covers include X-rays, PET scans, MRI, EKG, and CT scans. You have to pay your 20 percent 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 go here to look through the list of covered tests from Medicare.
- Here is a list of codes and tests 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. Here are a few final tips to consider:
- Ask your doctor for information on your particular type of blood test and how to prepare (if you should or should not eat beforehand, etc).
- Visit providers that accept assignment to avoid paying out-of-pocket costs for covered services
- 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.