Does Medicare Cover Blood Tests?

Blood tests are a very important part of the medical field even today. A blood test can help in determining if you are suffering from a certain medical condition.

Aside from being used as a diagnostic tool, healthcare providers also make use of blood tests to monitor your health and know if you have a high risk of suffering from various diseases or other health issues.

So a common question many people have is, “Does Medicare cover Blood Tests?” In this article, we answer that question in clear, plain English. You will also find the average costs of blood tests and other helpful info.

Does Medicare Cover Blood Tests?

The short answer is yes; Medicare will cover the cost of your blood test. But not 100% of the time. As is often the case with Medicare, certain conditions must be met for Medicare to pay for your blood test. Below we look at what these are so you know what to expect.

Original Medicare (Medicare Part A and Part B) provides coverage for many types of blood tests.

If the blood test is done in an inpatient setting (like a hospital, skilled nursing facility, hospice, or home health) then Medicare Part A will cover the costs. Most of the time, Medicare Part A provides full coverage for in-hospital blood tests. However, you still need to meet your deductible.

Medicare Part B provides coverage for a medically necessary blood test if it takes place in an outpatient setting. Medicare Part B will pay for a medically necessary blood test if it is for diagnosing or managing a certain condition. Just like with Medicare Part A, you will need to meet your Medicare Part B’s yearly deductible for coverage.

Medicare Advantage plans (Medicare Part C) also provide coverage for many types of blood tests. They cover everything Original Medicare covers as well as offer some additional benefits. However, out-of-pocket costs will vary depending on the specifics of your plan. Medicare Part C may also provide coverage for some tests that Original Medicare does not cover.

Where To Get Blood Tests

Blood tests are done in several types of labs. Here are the types of labs where you can get a blood test that Medicare will typically cover:

Doctors’ offices
Independent labs
Hospital labs
Nursing facility labs
Other institution labs

Medicare does not cover every type of blood test though. If you receive or have to sign an Advanced Beneficiary Notice (ABN) from the service provider or lab, this may mean that you will pay for the whole costs of the blood test.

Types and Frequency of Blood Tests

Though both Original Medicare and Medicare Advantage plans provide coverage for many types of blood tests, there are limits as to how frequently they will cover a specific test.

Here are some of the conditions that are commonly screened through a blood test, as well as how frequent Medicare covers blood tests for:

Diabetes: once a year, or twice if you are at higher risk
Heart disease: once every five years
HIV: once a year depending on the risk
Sexually transmitted disease (STD): once a year
Hepatitis B and C: once a year depending on the risk
Prostate Cancer: once a year

How Much Do Blood Tests Cost?

Blood tests costs can range from under $100 to well over $1,000. How much depends largely on where you get the blood test and how many blood tests your doctor orders.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.