Medicare covers many common laboratory tests and diagnostics needed to keep you healthy or diagnose a symptom. This includes many blood tests for things like hepatitis, sexually transmitted infections (STIs), triglycerides, cholesterol, lipids, and most preventive care lab tests. In this MedicareWire.com article, we’ll explain what lab tests Medicare covers.
- Blood tests are diagnostic methods to determine potential risks or conditions in a patient.
- Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Part B provide coverage for blood tests ordered by a doctor to diagnose or screen for a condition.
- Medicare fully covers the cost of blood testing after the beneficiaryA person who has health care insurance through the Medicare or Medicaid programs. has paid their deductibleA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share..
- A MedigapMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. plan can help with any out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. for diagnostic tests like blood testing.
- Medicare fully covers blood tests for beneficiaries with high-risk conditions, such as cancer.
- Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). will cover blood tests, but the beneficiary will have to use providers within the plan.
- MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. can help with blood test costs after Medicare has paid its share.
Blood tests are covered under Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. (medical insurance) if you have Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage.. If you have a Medicare Advantage plan, your plan must offer the same basic coverage benefits as Original Medicare, however, your primary care doctor will likely need to order your blood test for you. You can find your Medicare Advantage plan’s lab test copay costs here.
What Are Blood Tests?
A blood test is performed to analyze your blood for any potential problems that preventive care can minimize. A doctor will use a needle to extract a blood sample from your arm, or they may use a finger prick to extract a small blood sample from your finger instead. Medically necessaryServices or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice. blood tests are done to confirm things such as:1hopkinsmedicine.org, “Blood test“, Accessed November 10, 2021
- Heart disease
- Cholesterol levels
- Triglyceride levels
- Lipid levels
- Sexually transmitted infections (STIs)
- Organ health
- Vitamin deficiencies
What Blood Tests Does Medicare Cover?
Original Medicare coverage will only pay for blood tests performed at Medicare-approved testing facilities. These facilities accept payment from Medicare. This includes not only the location where the blood draw is done but also the laboratory that performs the test (if it’s not on-site).2Medicare.gov, “Clinical laboratory tests“, Accessed November 17, 2021
In general, Medicare covers all blood tests ordered by your doctor for a medically necessary purpose. In other words, if your doctor needs a test to determine your health status, Medicare covers it. Medicare will not cover a blood test unless it is ordered by your doctor. This includes your annual wellness visit.2Medicare.gov, “Clinical laboratory tests“, Accessed November 17, 20213Medicare.gov, “Yearly wellness visit”, Accessed November 17, 2021
Medicare typically covers a portion of blood tests that are done to confirm an illness or measure vital conditions, such as your cholesterol level. However, because these tests are covered under Medicare Part B. Before Medicare pays anything for your laboratory tests, you must pay the annual Part B deductible.4Medicare.gov, “What Part B Covers”, Accessed November 17, 2021
Blood tests that are done as part of an inpatient hospital stay, skilled nursing facility stay, home healthcare visit, or hospiceHospice is a special way of caring for people who are terminally ill. Hospice care involves a team-oriented approach that addresses the medical, physical, social, emotional, and spiritual needs of the patient. are generally covered by Medicare Part A. Often doctors leverage these tests to make diagnoses and direct treatment plans.5Medicare.gov, “What Part A Covers”, Accessed November 17, 2021
Medically necessary blood tests are done to confirm things such as diabetes, infections, vitamin deficiencies that are causing illness, and more. You need to check directly with Medicare to ensure that the tests your doctor orders are covered by your policy. In some instances, Medicare may also pay a portion of preventive blood tests. If this is the case, you would only be responsible for your portion of the co-pay or coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. after the deductible is met.4Medicare.gov, “What Part B Covers”, Accessed November 17, 2021
If you have Original Medicare and a Medigap plan (learn more here) to help pay the out-of-pocket costs associated with blood tests, your Medigap plan will cover its share up to the limits of the plan.6Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed November 17, 2021
What About High-Risk Health Conditions?
If your doctor has diagnosed you as a higher-risk patient, due to obesity, heart disease, or another high-risk chronic health condition, the screening tests needed to monitor your health condition are covered by Medicare.7Medicare.gov, “Cardiovascular disease screenings“, Accessed November 17, 2021
Medicare also covers high-risk cancer screenings for both men and women, including the prostate-specific antigen (PSA) test and Pap smear. These tests are available at no cost to Medicare beneficiaries when ordered by their doctor.8Medicare.gov, “Prostate cancer screenings“, Accessed November 17, 20219Medicare.gov, “Cervical vaginal cancer screenings“, Accessed November 17, 2021
Does Medicare Advantage pay for blood tests?
Another option that many Medicare beneficiaries choose is Medicare Advantage. These plans are offered through private insurance companies and often include benefits above and beyond what Original Medicare covers. At a minimum, they must offer the same services as Medicare Parts A and B. But they also can include other medical coverage such as vision care, dental care, weight loss services, and more.10Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 17, 2021
Medicare Advantage plans vary in price and coverage. They do pay for diagnostic tests including blood tests, medically necessary scans, and more. Your costs under Medicare Advantage may be different than Original Medicare. Some of these plans have higher out-of-pocket costs, but low monthly premiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. .10Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 17, 2021
If you have a Medicare Advantage plan and need blood work, you will have a copayment that’s specified in the plan’s summary of benefits. MedicareWireMedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. offers free summary-of-benefits downloads on its Medicare Advantage plan pages. Advantage plans may cover some tests not covered by Original Medicare, so check with your health care provider or plan if you’re not sure.
If you are thinking of switching from Original Medicare to Medicare Advantage, speak with a licensed insurance agent who can help you find the best plan and get you through the enrollment process.
Does Medicaid Pay for Blood Tests?
If you qualify for both Medicare and Medicaid, in most cases Medicaid will cover nearly all of your costs for blood work. Visit www.medicare.gov to learn more about how to qualify.11Medicaid.gov, “Early and Periodic Screening, Diagnostic, and Treatment“, Accessed November 17, 2021
Does Medicare Part D Cover Blood Tests?
Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... is an optional coverage that helps pay for your prescription medications. It does not cover blood work.12Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 17, 2021
Most blood tests you need to diagnose a problem, detect a health issue early, and keep you healthy are covered by Medicare. Many of these tests are covered at no cost to you during your annual wellness visitMedicare's annual wellness visit is a preventative care service provided to its beneficiaries at no cost. The annual wellness visit is available every twelve months after the beneficiary's initial "Welcome to Medicare" preventative visit., so be sure to discuss your needs with your doctor.
- 1hopkinsmedicine.org, “Blood test“, Accessed November 10, 2021
- 2Medicare.gov, “Clinical laboratory tests“, Accessed November 17, 2021
- 3Medicare.gov, “Yearly wellness visit”, Accessed November 17, 2021
- 4Medicare.gov, “What Part B Covers”, Accessed November 17, 2021
- 5Medicare.gov, “What Part A Covers”, Accessed November 17, 2021
- 6Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed November 17, 2021
- 7Medicare.gov, “Cardiovascular disease screenings“, Accessed November 17, 2021
- 8Medicare.gov, “Prostate cancer screenings“, Accessed November 17, 2021
- 9Medicare.gov, “Cervical vaginal cancer screenings“, Accessed November 17, 2021
- 10Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 17, 2021
- 11Medicaid.gov, “Early and Periodic Screening, Diagnostic, and Treatment“, Accessed November 17, 2021
- 12Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 17, 2021