Does Medicare Cover Lab Work?

Sure, many health conditions have physical signs and symptoms that alert us that something isn’t quite right. But to truly know what’s going on with our health, we need to know what’s going on inside our bodies. And lab work is the main way the doctors do that.

By using samples of blood and/or other body fluids, there’s a lot doctors can learn about our overall health and wellness. They can also use the results of lab tests to detect potential health issues early, when they may be easier to treat.

No, it’s not fun to get stuck with a needle or have other samples taken. But the information we get from lab tests can be lifesaving.

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

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

Original Medicare (Medicare Part A and Part B) provides coverage for lab work. Coverage for lab works falls under Medicare Part A if you are in a hospital or other inpatient setting. In these settings, healthcare providers often need lab work to diagnose or monitor your condition. Medicare Part A will cover these costs.

If you need lab work done but are not in the hospital, Medicare Part B will provide coverage for the costs. However, for Medicare Part B to cover your lab work, your healthcare provider must order it. And, as is usually the case with Medicare, the lab work must be medically necessary. Also, you must get it done at a Medicare-approved facility in order to get Medicare to pay for it.

Medicare Advantage plans (Medicare Part C) also provide coverage for lab works. They cover everything Original Medicare covers, as well as some additional benefits. However, exactly what they cover and how much the out-of-pocket costs are will vary depending on the specifics of your plan.

How Much Does Lab Work Cost?

The cost of lab work ranges from $100 to over $1,000. The overall cost of your lab work will depend on what type of lab test you receive and where you get the lab work.

Here are some prices of some labs in California to give you an idea of the costs of common lab tests without insurance:

Complete Blood Count can cost from $140 to over $620
Thyroid Stimulating Hormone can cost from $150 to nearly $1,140
Liquid Panel can cost from $300 to over $840
Basic Metabolic Panel can cost from $330 to over $1,300.
Urinalysis can cost from nearly $130 to $650
STD Testing can cost from nearly $100 to $350

Common Lab Tests

Complete Blood Count – this lab test measures the types and number of cells in your blood.
Prothrombin Time – this test measures how long it takes for your blood to clot.
Basic Metabolic Panel – a test of 9 different substances in the blood that provides doctors with information about our chemical balance and metabolism.
Liquid Panel – this is a group of tests that helps evaluate cardiac risks.

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.