Does Medicare Pay for Bloodwork?

When does Medicare cover blood work? When they’re ordered by a doctor to monitor or test for certain conditions, such as diabetes, sexually transmitted diseases, hepatitis, heart disease and other conditions.

A blood test is covered by Medicare if your doctor decides it is medically necessary.

Some privately sold Medicare Advantage (Medicare Part C) plans may cover additional blood work and other lab tests that federally administered Original Medicare (Part A and Part B) doesn’t cover, though these additional benefits may vary from one plan to the next.

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What Tests Does Medicare Cover?

Some of the blood tests covered by Medicare include tests for:

1. Diabetes – Medicare covers a blood test for diabetes once per year, or up to twice per year for high-risk individuals who have risk factors such as a history of high blood pressure or hypertension, a history of abnormal cholesterol or triglyceride levels, a history of high blood sugar or obesity.
   
   
2. Heart disease – A  blood test is covered by Medicare once every five years to check your cholesterol, lipid (blood fat) and triglyceride levels to determine if you’re at risk for a heart attack or stroke.
   
   
3. HIV – Medicare covers blood tests for HIV screening once a year based on risk. Pregnant women can get an HIV blood test covered by Medicare up to 3 times during their pregnancy.
   
   
4. Hepatitis B & C – An HBV infection screening is covered by Medicare if you’re at elevated risk for Hepatitis B or if you’re pregnant. The blood test is covered once a year if you’re at high risk, and it’s covered at various points of your pregnancy depending on your risk level. Medicare covers Hepatitis C blood tests once a year if you’re at high risk or meet certain other factors.
   
   
5. Colorectal cancer – Medicare covers a fecal occult blood test screening once a year if you’re 50 or older and have a referral form your doctor or other health care professional.
   
   
6. Prostate cancer – Once a year, Medicare covers prostate specific antigen (PSA) blood tests for men over 50.
   
   
7. Various sexually transmitted diseases – Medicare covers blood tests for sexually transmitted infections (STI) once a year. The tests screen for chlamydia, syphilis, Hepatitis B and/or gonorrhea.
   
   
8. Coronavirus disease 19 (COVID-19) antibody test
   Also called a serology test, coronavirus tests are covered to see if your immune system responded to COVID-19 exposure and infection.

Medicare Part B covers clinical diagnostic lab tests such as blood tests, tissue specimen tests, screening tests and urinalysis when your doctor says they’re medically necessary to diagnose or treat a health condition.

How Much Do Blood Tests Cost With Medicare?

Medicare Part B provides coverage for medically necessary clinical diagnostic laboratory services when ordered by a doctor according to the timelines above. Beneficiaries typically do not pay anything for these blood tests as long as they are performed by a Medicare-approved health care provider. 

However, if more frequent blood tests are needed due to your risk factors or health condition, you may be required to pay 20% of the blood test cost of the Medicare-approved amount after you meet your annual Part B deductible. 

Medicare Advantage plans are required by law to provide all of the same benefits as Original Medicare. This means all Medicare Advantage plans also provide coverage for blood tests prescribed by a doctor. Your coinsurance, copays and deductible amounts may vary depending on your plan.

Does Medicare Cover Other Annual Tests?

Medicare lab coverage includes a number of other services in addition to blood tests. Depending on qualifying criteria, you may pay nothing for these tests.  

Some of the additional tests covered by Medicare include:

• Mammograms for breast cancer
• Pap smears for cervical cancer
• Bone density tests for osteoporosis 
• Stool tests, enemas, colonoscopies and flexible sigmoidoscopies for colon cancer
• Abdominal ultrasounds for aortic aneurysms 
• Low dose computed tomography (LDCT) for lung cancer
• Eye tests for glaucoma

Medicare also covers screenings for alcohol and substance abuse and obesity.

Once a year, beneficiaries are covered for an annual wellness visit. The visit does not include any blood tests but does feature other tests and screenings for various health issues. 

The official Medicare website provides this detailed list of the types of tests, items and services that are covered.

Medicare Advantage plans must cover at least the same tests as Original Medicare, and some plans may also cover additional tests. Check with your plan carrier directly to find out if your blood tests will be covered.