Medicare typically covers the cost of thyroid tests if a doctor deems them necessary. The diagnostic tools allow the healthcare provider to understand if someone has problems with their thyroid gland.
The thyroid gland, located in the neck, produces hormones that regulate metabolism. If an individual has a thyroid condition, they may experience weight control issues or cardiovascular complications.
This article explores thyroid dysfunction and discusses how Medicare covers thyroid and other blood tests. It also looks at treatments and therapies for thyroid dysfunction and examines costs.
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.
Thyroid dysfunction happens when the thyroid gland either makes too much or too little thyroid hormone.
The thyroid gland has two lobes on either side of the windpipe below the voice box or larynx. This endocrine gland makes two thyroid hormones, T3 and T4, which are chemical messengers controlling metabolism, growth, and mood.
If the thyroid gland does not make enough hormones for the body, this leads to hypothyroidism or an underactive thyroid. If the thyroid produces too much hormone, the individual experiences hyperthyroidism or overactive thyroid.
In hypothyroidism, symptoms include:
- fatigue
- joint and muscle pain
- intolerance to cold
- weight gain
With hyperthyroidism, symptoms relate to increased metabolic rate and include:
Both forms of thyroid dysfunction affect the body in various ways and can lead to a range of symptoms. However, people with minor thyroid dysfunction may not experience any symptoms.
Different parts of Medicare cover the costs of thyroid tests and treatment.
Original Medicare
Original Medicare is Part A, which is hospital insurance, and Part B, which provides medical insurance.
Medicare Part A covers the cost of inpatient stays in a hospital, clinic, or other nursing facilities. Medicare Part B covers medically necessary services in an outpatient setting, doctor’s visits, and prevention services, including diagnostic and blood tests.
Generally, Medicare covers thyroid testing under Part B, as long as a doctor has ordered the test to diagnose or treat a medical condition.
However, Part A covers the cost if a person is in a hospital or nursing facility, and a doctor orders a thyroid test during their inpatient stay. Medicare Part A also covers the cost if the doctor recommends surgical removal of the thyroid gland.
Learn more about the removal of the thyroid gland here.
Medicare Advantage plans
People who qualify for Medicare can choose to get coverage through original Medicare (Parts A and B) or a through a Medicare Advantage plan.
While Medicare Advantage plans offer the same basic coverage as original Medicare, private insurance companies offer the plans, which means they may offer additional benefits, such as dental, vision, and hearing care. Many Advantage plans also provide Medicare Part D prescription drug coverage.
Learn more about choosing a Medicare Advantage plan here.
Medicare Part D
Medicare Part D is prescription drug coverage available to a person enrolled in original Medicare. Private insurance companies offer these plans.
If a doctor prescribes medication because a person has a mild thyroid condition, Medicare Part D covers the cost. People should check their plan’s list of drugs, called a formulary, to confirm coverage of thyroid medications.
The various treatments and therapies for thyroid dysfunction depend on the severity of a person’s condition. Medication is generally the first line of treatment.
Hypothyroidism
Treatment usually includes synthetic thyroxine, which replaces the T4 hormone. The dosage depends on the levels of thyroid-stimulating hormone (TSH) in a person’s blood.
Doctors use blood tests to monitor hormone levels and then adjust the dose of thyroxine as necessary.
Doctors may also recommend a dietary plan that improves iodine intake, including certain vegetables and soy products. Iodine is essential to healthy thyroid function.
Learn more about TSH tests here.
Hyperthyroidism
Doctors prescribe medications that either treat the symptoms of hyperthyroidism or address hormone production. Medications may include:
- Beta-blockers to relieve symptoms such as anxiety and heart palpitations.
- Antithyroid drugs, such as methimazole or propylthiouracil, to prevent the thyroid gland from producing too much thyroid hormone.
- Radioactive iodine, which destroys active cells in the thyroid.
If the above treatments do not work or are not possible, surgery to remove the thyroid gland could be an option.
The cost of a thyroid blood test varies according to the laboratory and the location. Medicare covers most clinical diagnostic tests, including thyroid tests, but a person will generally have some costs, as shown below.
Medicare Part A
If a doctor orders a thyroid test while a person is an inpatient, Medicare Part A covers the cost after a person has met their deductible. The Part A deductible is $1,484 in 2021 for each benefit period. A benefit period starts as someone enters the hospital and continues for 60 days.
Medicare Part B
Medicare Part B covers the total cost for thyroid tests. However, a person must meet the annual deductible of $203. Other costs include the basic Part B monthly premium, which is $148.50 in 2021.
Medicare Advantage plans
Costs for Advantage plans differ. In addition to paying the standard Part B premium, a person enrolled in an Advantage plan will pay the plan premium. In 2020, Advantage plan premiums averaged $25 per month.
Most people generally have zero costs for Medicare-covered clinical diagnostic tests, including thyroid tests. However, if a person needs help to cover the costs of thyroid treatment, they may find assistance from Medigap or Medicaid.
Medigap
A Medigap plan helps a person enrolled in Medicare pay out-of-pocket costs such as copays, deductibles, and coinsurance that Medicare does not cover. Private insurance companies offer 10 Medigap plans with different levels of cover.
Costs vary by location and plan and can range from $64 to $500 per month.
Learn more about Medigap here.
Medicaid
Medicaid helps low-income, low resource households to access healthcare services. The government funds this program, and individual states set the eligibility criteria for income and assets.
Original Medicare (Part A and Part B) and Medicare Advantage plans offer the same level of coverage for thyroid tests. Medicare Part B covers the cost of a blood test done as an outpatient, while MEdicare Part A covers the costs of a thyroid blood test done as part of an inpatient hospital stay.
Both Medicare Part D and Medicare Advantage plans cover the cost of thyroid medication. Medicare Part A also covers the cost of surgery if a doctor deems it necessary to remove the thyroid gland.
The thyroid gland is a small hormone-producing gland in the neck. People can experience problems if they produce too much or too little thyroid hormones that control metabolism and growth.