- Quest Diagnostics offers many laboratory tests and screening services.
- Medicare covers tests performed at Quest, as long they’re medically necessary and the specific facility accepts Medicare.
- Medicare Part B or Medicare Advantage (Part C) will cover the cost of your tests.
- Most tests will come at no cost to you once you’ve met your plan’s deductible.
Quest Diagnostics is one of the largest providers of outpatient testing in the world. The company has more than 2,000 locations in the United States alone.
Medicare covers many of the services provided by Quest, including blood tests and other preventive screenings.
With Medicare, you usually won’t pay anything out of pocket for most medically necessary tests at Quest Diagnostics. To receive full coverage, both the healthcare provider who orders the test and the Quest location you use must participate in Medicare.
You’ll also need to meet your plan’s annual deductible before Medicare will cover most tests.
You can use Quest Diagnostics for many tests your doctor might order. If you have original Medicare (parts A and B), Medicare Part B will generally cover your tests.
However, your test must meet some specific criteria:
- It must be ordered by a doctor.
- That doctor must participate in Medicare.
- The test must be for a diagnostic service that Medicare covers.
- The Quest Diagnostics location must participate in Medicare.
In general, this means your doctor suspects you may have a condition or are at risk for one.
This may be due to significant family history or symptoms you’ve been experiencing. If you haven’t had any symptoms and you don’t have a family history of a condition, Medicare might not pay for your test, no matter where you get it.
It’s also important that the Quest Diagnostics location you visit participates in Medicare.
Each state has its own regulations for Medicare facilities. You can check if Medicare covers the Quest Diagnostics near you by using this map. You can also ask the doctor who orders your test or the staff at Quest if your test will be covered.
If you’re still not sure or have additional questions, you can call Medicare directly at 800-MEDICARE (TTY: 877-486-2048).
Medicare Part A coverage
Medicare Part A is hospital insurance. It’ll cover tests ordered by your doctor during your stay in a hospital or skilled nursing facility. But it doesn’t cover testing at outpatient labs, like Quest Diagnostics.
Medicare Advantage coverage
Medicare Advantage (Medicare Part C) offers plans through private insurance companies regulated by Medicare. Medicare requires all these plans to cover the same services as original Medicare.
This means that your Medicare Advantage plan will cover any testing that Medicare Part B does.
Many Medicare Advantage plans have networks, however, and you’ll need to stay in network for any testing to receive full coverage. If you go to an out-of-network doctor or facility, you’ll pay a much higher price — or your test might not be covered at all.
Quest Diagnostics is in network for many major providers of Medicare Advantage plans, including:
- Anthem (most plans)
- BlueCross BlueShield (most plans)
You can check with your plan to see if the Quest Diagnostics location near you is part of the network.
Medicare parts A and B will cover medically necessary tests at no cost to you. However, both your doctor and the facility you use will need to be Medicare participants that accept Medicare payments for services.
You can find participating doctors in your area on the Medicare website. Check that both the doctor and lab accept Medicare before you get any testing done, so you don’t end up paying any surprise costs.
Medicare Part B costs
Other than possible costs for the test itself, Medicare Part B has a premium. You’ll need to pay it each month to keep your coverage.
In 2020, most people pay $144.60 per month for Part B coverage.
Medicare Part B also has an annual deductible. In 2020, the deductible is $198. You’ll need to meet your deductible before your test is covered.
Medicare makes an exception, though, for routine testing for heart disease. In this case, Medicare will completely cover the screening once every 5 years, even if you haven’t met your deductible for the year.
For all other tests, you’ll need to meet the $198 deductible first.
Medicare Advantage costs
When you’re using a Medicare Advantage (Part C) plan, your deductible and premium will depend on your specific plan.
You’ll also need to make sure that the Quest Diagnostics near you is part of your plan’s network.
If it’s not and you still wish to go to Quest, you may need to pay for the test completely out of pocket. This applies even if your plan covers the test.
Medicare will cover many types of tests.
Check out the table below for some of the most common ones. Most tests are only covered once a year, unless otherwise noted.
|Type of test||Reason (frequency)|
|Blood tests and screenings||Diabetes (can be covered up to twice a year), heart disease (covered every 5 years), HIV, hepatitis, STD, prostate cancer, colon cancer|
|Urinalysis tests||Can help diagnose many health concerns, including kidney and liver disease|
|Specimen tests||Fecal occult blood tests to screen for colon cancer, tissue sample biopsies to screen for multiple cancer types|
|Other screenings||Cervical cancer, vaginal cancer, bone mass measurements to screen for osteoporosis (covered every 2 years), lung cancer screenings|
Not all Quest Diagnostics locations offer every test or screening procedure covered by Medicare. Check with your local Quest to make sure it can provide the test your doctor has ordered.
Your doctor might be able to recommend other local labs if Quest Diagnostics doesn’t offer the test you need.
You can use Medicare at Quest Diagnostics to get coverage for a wide range of tests your doctor might order. Here are a few other points to remember:
- Your doctor and the Quest location you use must participate in Medicare.
- Both Part B and Medicare Advantage plans will cover medically necessary diagnostic tests.
- You won’t pay any out-of-pocket costs for testing if you’ve already met your plan’s annual deductible.
- You can check with your doctor, your local Quest, and Medicare to make sure your test will be covered.
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