Medicare covers blood tests that a doctor seems medically necessary. Medicare Advantage offers at least the same coverage. If a person needs multiple laboratory tests, they may need to pay for part of the cost.
Original Medicare, which includes Part A and Part B, covers blood tests when a doctor orders that a person should undergo them. Medicare Advantage, which is the alternative to original Medicare, offers at least the same coverage.
Someone with coverage from original Medicare will usually have no charge for diagnostic blood tests, but someone with a Medicare Advantage plan may be responsible for copayments.
This article explains how Medicare covers blood tests and what out-of-pocket costs a person may still have to pay. It also discusses the common blood and laboratory 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.
Medicare Part B covers the majority of a person’s medically necessary blood tests and other diagnostic tests. To qualify, a person’s doctor must write an order for the test. If a person seeks a blood test on their own, however, they will likely have to cover the costs themselves.
In some cases, Medicare Part A will cover the costs of blood work. Typically, a hospital or care facility will bill Part A when the person is staying within the facility.
Medicare consists of three main parts:
- Part A: This is hospitalization insurance, which covers blood tests and other diagnostic laboratory tests that a doctor orders for a person during a hospital stay.
- Part B: This is medical insurance, which covers outpatient diagnostic laboratory tests when a doctor considers them necessary. These include blood tests, tissue specimens, urinalysis, and some screening tests.
- Part D: This covers the costs of prescription medications.
Medicare Advantage, or Medicare Part C, offers an alternative to Medicare parts A, B, and D. Medicare Advantage consists of Medicare-approved, private insurance companies that must follow the guidelines and rules of Medicare. Like parts A and B, Medicare Advantage plans cover the costs of blood work and other tests.
If a person with original Medicare goes to a Medicare-approved laboratory, they will typically pay nothing for most diagnostic 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 laboratory test more often than Medicare coverage allows or when a doctor orders a laboratory test that Medicare does not cover.
For a diagnostic test, such as an X-ray, an individual will still pay 20% of the cost. The Part B annual deductible of $203 also applies.
To help with the cost when Medicare does not cover medical tests, people with original Medicare have the option of buying a Medigap plan, which is Medicare supplement insurance, from a private company.
Medigap plans can help cover the costs of:
- copayments
- deductibles
- coinsurance
In order to qualify for a Medigap plan, a person must have both Part A and Part B. They cannot get Medigap if they have Medicare Advantage.
A person with Medicare Advantage may be responsible for copayments and coinsurance. These costs vary among plans. Someone with a Medicare Advantage plan may also need to go to an in-network laboratory to get lower costs.
Medicare covers most diagnostic blood tests, including the following.
Complete blood count
A complete blood count helps detect clotting problems, immune system disorders, blood cancers, and blood disorders such as anemia.
- red blood cells, which transport oxygen to all parts of the body
- white blood cells, which fight infections
- platelets, which are the fragments that enable the blood to clot
- hemoglobin, which is the part of the red blood cells that carries oxygen
Blood chemistry test
The blood chemistry test, also called a basic metabolic panel (BMP) test, 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 calcium, glucose, and electrolyte levels. These 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 that a person has had a heart attack. Medicare will usually cover such tests.
For example, one of these enzymes, called troponin, is a muscle protein that increases when an injury occurs in heart cells. In turn, this creates kinase, which is a blood product that the body releases when an injury occurs in the heart muscle.
Lipoprotein panel
Medicare covers a lipoprotein panel every 5 years. This test helps show whether or not a person is at risk of heart disease.
The panel measures:
- total cholesterol, which is a fatty substance that can build up in the arteries
- triglycerides, which refers to a type of fat in the blood
- low-density lipoprotein, which is the main source of artery blockages
- high-density lipoprotein, which helps reduce artery blockages
Thyroid-stimulating hormone test
Having high levels of thyroid-stimulating hormone, which is made in the brain, indicate that the thyroid gland is not making enough hormones. Having low levels of this hormone indicate the gland is making too much. Medicare coverage usually applies under part B.
Thyroid hormones should be within a certain range for the optimal regulation of body temperature, weight, and muscle strength.
When a person gets a checkup, a doctor may order laboratory tests other than standard blood tests. Medicare usually covers these tests. They may include the following.
Urinalysis
Urinalysis checks the acidity, color, and appearance of urine. It also measures substances not usually present in urine, such as blood and bacteria.
This test helps doctors diagnose urinary tract infections, diabetes, and kidney infections.
Fecal occult blood test
Medicare covers a fecal occult blood test once every 12 months for people aged 50 years or above.
The test checks for blood in the stool that a person cannot see with the naked eye. If the result is positive, it may indicate that some part of the digestive tract is bleeding. The bleeding may be due to many causes, such as ulcers or abnormal growths called polyps.
Pap test
Medicare generally covers Pap tests every 2 years for females, though some situations may require more frequent tests. For example, if a person had an abnormal Pap test in the previous 3 years and is of child-bearing age or at high risk of certain cancers, Medicare covers a Pap test once per year.
The test allows doctors to look for changes and precancerous cells in the cervix, which is the lower end of the uterus. An anomaly may suggest the presence of cells that could develop into cervical cancer.
Prostate-specific antigen test
Medicare covers prostate-specific antigen tests once per year for males aged 50 years and older.
Prostate-specific antigen is a protein made by both healthy and cancerous cells of the prostate gland. Levels are often high in people with prostate cancer.
Original Medicare (parts A and B) covers medically necessary blood tests. A person with this coverage will usually pay nothing for most diagnostic laboratory 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 a Medigap plan, 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 laboratories to get lower costs.