Does Medicare Cover Lab Work?

Does Medicare Cover Lab Work? The importance of routine medical tests cannot be overstated. It can be necessary to test blood or other bodily fluids for disease screening or infection detection. Modern medical testing equipment and techniques allow doctors to diagnose an array of conditions with minimal blood. This can make treatment more effective and faster for patients. Laboratory testing can reduce the need for time-consuming and expensive diagnostic procedures and scanning tests, that generally would require increased patient effort and preparation.

Medicare Benefits Solutions

Jul 21, 2021

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Medicare benefits for lab work

If you have been formally admitted into a hospital, Medicare Part A (Hospital Insurance) usually covers you. Hospital lab testing will probably be required to diagnose or manage your health condition and will be covered. If you still need lab work after being discharged from a hospital or medical facility and go to a Medicare-approved laboratory, Medicare Part B will cover the lab costs.

A physician’s order for outpatient services and care, including lab work, is covered by Part B (Medical Insurance) as long as you see a Medicare-approved doctor that accepts the Medicare assignment and orders the appropriate test for diagnosis, treatment or monitoring.

Choosing to have lab work performed on your own, however, may not be covered. The same tests that doctors order regularly are available at many independent laboratories, but you would be responsible for the cost of these tests if you seek them on your own. Sometimes, though, you may be exempt from this rule if you cannot go to the specific facility from which your doctor ordered lab work. Sometimes, you might be able to appeal if there is a closer alternative that will perform the same tests.

Besides their Part A and Part B Medicare benefits, Medicare Advantage plans often include additional benefits. For more information about lab work coverage, please refer to your specific plan.

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Where can Medicare recipients go for testing?

A variety of labs can perform blood tests for you. You will find out where you can get testing done from your doctor. Be sure to verify whether the facility or provider accepts Medicare assignment and is currently participating in Medicare. 

Types of labs include:

  • Nursing facility labs
  • Doctors’ offices 
  • Independent labs 
  • Hospital labs

The lab or service provider may ask you to sign an Advance Beneficiary Notice (ABN) before you receive a service, in which case you will be responsible for the charge. Make sure you know what costs are your responsibility before you sign.

Costs of lab tests for Medicare recipients

Medicare will pay for clinical diagnostic lab tests that your doctor orders if they are medically necessary. Typically, you will not have to pay anything for the tests. Lab tests could include urinalysis, blood tests, tests on tissue specimens and screening tests.

A lab that is Medicare-approved must perform the laboratory services. There are, however, coverage exceptions, such as if a doctor orders a lab test more frequently than Medicare coverage allows, or Medicare does not cover a particular lab test.

Blood tests and other lab screenings or diagnostic tests may incur a wide range of costs. Your location, the type of test, and the location of the lab will affect the price. You must verify coverage before getting the test done.

Medicare Part A covers a doctor’s order for blood work in the hospital. However, you still must meet your deductible. In 2021, most beneficiaries will pay $1,484 in Part A deductibles. 

Medicare Part B covers outpatient blood tests. However, this coverage also carries a deductible. Beneficiaries will still have a deductible of $203 in 2021, along with the monthly premium of $148.50. 

For beneficiaries enrolled in Medicare Advantage, the plans will have different prices depending on their coverage. Some Medicare Advantage plans may require you to have tests conducted at in-network labs to receive lower costs. 

Original Medicare recipients can buy one of eleven different Medigap, or Medicare Supplement, plans that can help pay some of the costs not covered by Medicare. Medigap can help with a lot of out-of-pocket fees, like certain deductibles, coinsurance and copayments.

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