Does Medicare Cover Lab Work?

Medicare Benefits Solutions
Jul 21, 2021

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.

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.

This may have you wondering if Medicare covers lab work. 

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Medicare Benefits for Lab Work

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.

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.

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Common Bloodwork and Lab Tests

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 Medicare coverage before getting the test done.

Top bloodwork and lab work tests include:

  • Urinalysis
  • CBC – complete blood count
  • CMP – comprehensive metabolic panel
  • Lipid panel to check triglycerides and cholesterol
  • HbA1c to test blood sugar
  • Thyroid panel
  • Cardiac biomarkers
  • Nutrient tests to check levels of vitamin D and other important nutrients

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Medicare Advantage and Medigap

Choosing to have lab work performed on your own may not be covered by Medicare. 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.

Besides Part A and Part B Medicare benefits, Medicare Advantage plans often include additional benefits. 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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Labwork Testing Sites for Medicare Recipients

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 such as Labcorp or Quest Diagnostics
  • 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 all the facts when navigating Medicare costs before you sign.

TIP: Find out which Medicare plans offer the best coverage for lab work and other testing services and compare against your existing coverage.

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