Will Medicare Cover Blood Tests?

Medicare and blood tests

Medicare covers blood tests when they’re used to monitor and prevent certain diseases or conditions. Or if deemed necessary by your health care professional. They must be ordered by your physician to be covered in any situation. Most privately sold Medicare Advantage plans will cover additional blood work that Original Medicare doesn’t cover, and each plan will vary slightly.

Medicare Part B will many times cover clinical diagnostic labs 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. 

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The List

These are some of the blood tests covered by Medicare:

  • Diabetes: Medicare will cover a blood test to check for diabetes once per year. If you’re at a higher risk for developing diabetes exhibiting any signs such as high cholesterol, family history, etc. It will be paid twice per year.
  • Heart Disease: Medicare will allow a blood test to check for all factors related to heart (cardiovascular) disease once every 5 years.
  • Prostate cancer: For men over 50, a prostate-specific antigen (PSA) blood test once a year is important and will be covered by Medicare Part B.
  • Colorectal cancer: If you’re 50 or older and have a referral from your doctor or other health care professional, Medicare covers a fecal occult blood test screening once a year.
  • Hepatitis B & C: Once a year if you’re at high risk or pregnant, the HBV infection screening is covered by Medicare. And it’s covered at various points of your pregnancy depending on your risk level. Medicare also covers Hepatitis C blood tests if you fall into a high-risk category or meet certain other factors. This will be covered once a year as well.
  • Sexually Transmitted Diseases: Medicare will cover blood tests to screen for sexually transmitted infections once a year. It commonly includes a screen for chlamydia, syphilis, Hepatitis B, and/or gonorrhea.
  • HIV: Medicare covers blood tests for HIV screening once a year based on risk. Pregnant women can get up to 3 additional tests during their pregnancy.
  • Coronavirus – COVID-19: Also called a serology test, coronavirus tests are covered to see if your immune system responded to COVID-19 exposure and infection.

How Much Do Blood Tests Cost With Medicare?

It’s hard to pinpoint an exact amount. Medicare Part B will provide coverage for necessary blood tests when ordered by a doctor. Policyholders typically do not pay anything for these blood tests as long as they are performed by a health care provider that’s approved or in-network.

If you have risk factors or health concerns that require you to get tested more often, you may be responsible for paying a 20% coinsurance of the approved amount (after you meet your annual Part B deductible). 

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Medicare Advantage plans are required to provide all of the same benefits as Original Medicare. This means they also provide coverage for blood tests prescribed by a doctor. Deductibles, co-pays, or any other fees will vary slightly among plans.

Talk with an Expert

For more information about whether Medicare covers your particular item, test, or service, please call us at (704) 765-4689.