Medicare Part B covers clinical laboratory tests for diagnostics when your doctor orders them. This includes urinalysis, blood tests, tissue specimen tests, and certain screening tests. Medicare also covers many preventative screenings and tests to help prevent medical issues.
In this MedicareWire article, we’ll explain what you need to know about how Medicare covers your lab work.
Key Takeaways
- Lab work is used for diagnosing a patient’s medical conditions and/or any health risks they may have.
- Medicare Part B covers lab work for diagnostic and preventative services when ordered by a doctor.
- Medicare fully covers the cost of lab work ordered by a doctor after the beneficiary has paid their deductible.
- Medicare Advantage plans will cover lab work, but the beneficiary will have to use providers and laboratories within the plan.
What Is Lab Work?
Lab work in healthcare is any diagnostic test conducted in a clinical laboratory to help your doctor better understand your condition. If your doctor suspects you may have an undiagnosed health condition, they would submit an order to an outpatient lab for a lab test, such as Quest Diagnostics or LabCorp. The doctor would then collect a sample or specimen from you and send it to the lab for the ordered diagnostic evaluation and/or screening, such as:1mayoclinic.org, “Laboratory Medicine and Pathology“, Accessed November 10, 2021
- Allergy Testing
- Blood Testing
- Bone Density Testing
- COVID Testing
- Genetic Testing
- Stool Testing
- Tissue Sample Testing
- Urinalysis
- X-Rays
How Does Medicare Cover Lab Work?
Medicare Part B covers diagnostic and preventative care lab work when your doctor orders them with a Medicare-approved outpatient laboratory. The Centers for Medicare & Medicaid Services mandates that most preventive services be provided to beneficiaries at no cost. Medicare Part B (medical insurance) covers:2Medicare.gov, “Clinical laboratory tests“, Accessed November 10, 2021
- Abdominal aortic aneurysm screening
- Alcohol misuse screenings & counseling
- Bone mass measurements (bone density)
- Cardiovascular disease screenings
- Cardiovascular disease (behavioral therapy)
- Cervical & vaginal cancer screening
- Colorectal cancer screenings
- Depression screenings
- Diabetes screenings
- Diabetes self-management training
- Flu shots
- Glaucoma tests
- Hepatitis B shots
- Hepatitis B Virus (HBV) infection screening
- Hepatitis C screening test
- HIV screening
- Lung cancer screening
- Mammograms (screening)
- Nutrition therapy services
- Obesity screenings & counseling
- One-time “Welcome to Medicare” preventive visit
- Pneumococcal shots
- Prostate cancer screenings
- Sexually transmitted infections screening & counseling
- Shots:
- COVID-19 vaccines
- Flu shots
- Hepatitis B shots
- Pneumococcal shots
- Tobacco use cessation counseling
- Yearly “Wellness” visit
How Much Does Lab Work Cost?
You usually pay nothing for Medicare-approved tests and screenings provided that the lab performing the tests meets Medicare’s requirements. Medicare Part B fully covers all lab work ordered by your doctor once you have paid the annual Part B deductible.2Medicare.gov, “Clinical laboratory tests“, Accessed November 10, 2021
Medicare Advantage
Medicare Advantage plans must cover all laboratory services that are covered by Medicare Part A and Part B, in addition to any expanded services offered. This means that you have no out-of-pocket costs when getting lab work under Medicare Advantage as long as your doctor determines it is medically necessary.4Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 9, 2021
However, a beneficiary’s out-of-pocket costs for other covered services with a Medicare Advantage plan may be different than those with Original Medicare. Talk with your plan provider about the expected out-of-pocket costs for services that are not fully covered.4Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 9, 2021
Summary
Original Medicare and Medicare Advantage plans will cover lab tests ordered by your doctor once your deductible has been met. Rest assured that you will pay no out-of-pocket costs for lab work once your Medicare coverage begins. Consult with your doctor about getting a lab test if you are experiencing negative health symptoms.
Citations
- 1mayoclinic.org, “Laboratory Medicine and Pathology“, Accessed November 10, 2021
- 2Medicare.gov, “Clinical laboratory tests“, Accessed November 10, 2021
- 4Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 9, 2021