Original Medicare, Part A and Part B, covers blood tests when a person’s doctor orders them. Medicare Advantage, the alternative to original Medicare, offers at least the same coverage.
Someone with original Medicare usually has no charge for diagnostic blood tests, while an individual with an Advantage plan may be responsible for copayments.
Below, we examine Medicare coverage of blood tests and the costs involved. Then, we define blood tests and discuss common lab tests that Medicare covers.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Original Medicare comprises Part A, hospitalization insurance, and Part B, medical insurance.
Part A covers blood tests and other diagnostic lab tests that a doctor orders for a person during a hospital stay.
Part B covers outpatient diagnostic lab tests when a doctor considers them necessary, such as certain blood tests, tissue specimens, a urinalysis, and some screening tests.
Medicare Advantage, the alternative to original Medicare, also covers blood tests and other diagnostic lab tests.
Part D consists solely of prescription drug coverage, so it does not cover blood tests.
If a person with original Medicare goes to a Medicare-approved lab, they typically pay nothing for most diagnostic lab tests. However, there are exceptions when a person may need to pay part or all of the cost, such as when a doctor orders a lab test more often than Medicare coverage allows, or when a doctor orders a lab test that Medicare does not cover.
To help with the cost when medical tests are not covered by Medicare, people with original Medicare have the option of buying a Medigap plan, which is Medicare supplement insurance.
Some Medigap plans cover all copayments and coinsurance costs associated with Part B, while other Medigap plans cover only part of the costs.
A person with Medicare Advantage may be responsible for copayments and coinsurance. These costs vary among plans. Someone with an Advantage plan may also need to go to an in-network lab to get lower costs.
- how well the organs, such as the heart, kidneys, and liver, are working
- any heart disease risk factors
- how well the blood is clotting
- whether medications are working
Some tests require no advance preparation, but others require fasting for a certain number of hours.
During a blood test, a lab technician draws a small amount of blood, usually from a vein in a person’s arm. The procedure takes a short time. While it may cause short-term discomfort, most people do not experience a serious reaction.
When doctors use results from blood tests to diagnose a condition after factoring in other information. This information includes a person’s medical history, current symptoms, and vital signs such as pulse rate, blood pressure, and temperature.
Medicare covers most diagnostic blood tests, such as:
Complete blood count
Complete blood count helps detect clotting problems, immune system disorders, blood cancers, and blood disorders, such as anemia. It measures:
- red blood cells, which transport oxygen to all parts of the body
- white blood cells, which fight infections
- platelets, the fragments that enable the blood to clot
- hemoglobin, the part of the red blood cells that carry oxygen
Blood chemistry test
The blood chemistry test, also called a Basic Metabolic Panel (BMP), usually measures components of the fluid portion of the blood. These measurements give doctors information about how the muscles, bones, and certain organs, such as the kidneys, are working.
BMP tests determine levels of calcium, glucose, and electrolytes, which are essential minerals that maintain fluid levels.
Blood enzyme tests
Enzymes are responsible for chemical reactions in the body. Some tests may measure enzymes that indicate a person has had a heart attack.
For example, one of these enzymes, troponin, is a muscle protein that increases when an injury occurs in heart cells. In turn, this creates kinase, a blood product released when an injury occurs in the heart muscle.
Medicare covers a lipoprotein panel every 5 years. It helps show whether people are at risk of heart disease. The panel measures:
- total cholesterol, a fatty substance that can build up in the arteries
- triglycerides, a kind of fat in the blood
- low-density lipoprotein, the main source of a blockage in the arteries
- high-density lipoprotein, which helps reduce artery blockages
Thyroid-stimulating hormone test
High levels of thyroid stimulating hormone, which is made in the brain, indicate the thyroid gland isn’t making enough hormones, and low levels indicate the gland is making too much.
Thyroid hormones should be within a certain range for optimal regulation of body temperature, weight, and muscle strength.
When a person gets a checkup, a doctor may order lab tests other than standard blood tests. Medicare usually covers these tests. They may include:
A urinalysis checks the acidity, color, and appearance of urine. It also measures substances not normally found in urine, such as blood and bacteria. This test helps a doctor diagnose urinary tract infections, diabetes, and kidney infections.
Fecal occult blood test
Medicare covers a fecal occult blood test every year for someone who is aged 50 or above. The test checks for blood in the stool that a person cannot see with the naked eye.
If the result shows positive, it may indicate some part of the digestive tract is bleeding. The bleeding may be due to many causes, including ulcers or abnormal growths called polyps.
Medicare generally covers Pap tests every 2 years for females, although some situations may require more frequent tests. For example, if a person had an abnormal Pap test in the previous 3 years and is a person of child-bearing age, or a person at high risk for certain cancers, Medicare covers a Pap test once a year.
The test allows the doctor to look for changes and precancerous cells in the cervix, which is the lower end of the uterus. An abnormality may suggest the presence of cells that could develop into cervical cancer.
Prostate-specific antigen test
Medicare covers a prostate-specific antigen test once per year for males aged 50 and older. This is a protein made by both healthy and cancerous cells of the prostate gland. It is often high in males with prostate cancer.
Original Medicare covers blood tests that are considered medically necessary. An individual with this coverage usually pays nothing for most diagnostic lab tests. However, in some instances a person must pay a 20% coinsurance, and the Part B deductible applies.
To help pay uncovered costs, people with original Medicare may choose to buy Medigap, which is Medicare supplement insurance.
Medicare Advantage also covers blood tests, but coinsurance and copayments may apply. A person may also need to use in-network labs to get lower costs.
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