Original Medicare does cover blood tests when they are ordered by a doctor or other health care professional to test for, diagnose or monitor a disease or condition.
The blood test must be deemed medically necessary in order to be covered by Medicare. Original Medicare (Medicare Part A and Part B) does not cover routine blood work as part of a general physical examination or screening.
If the blood test is ordered while receiving inpatient care at a hospital or skilled nursing facility, it will be covered under Medicare Part A (hospital insurance).
If the test is ordered as part of outpatient care received at a doctor’s office or health clinic, it will be covered by Medicare Part B (medical insurance).
Medicare Advantage plans (Medicare Part C) are required to cover everything that is covered by Original Medicare, so the same coverage rules detailed above will apply.
Medicare Advantage plans are also able to provide additional benefits that are not covered by Original Medicare and are unique to each plan. It therefore may be possible to find a Medicare Advantage plan that offers more coverage for blood work than what is found in Original Medicare.
Call a licensed insurance agent at TTY Users: 711 24 hours a day, 7 days a week to learn about Medicare Advantage plan options available in your area.
If conducted in an inpatient care setting, the cost of the testing is subject to the Medicare Part A deductible, which is $1,364 per benefit period in 2019.
In an outpatient setting, the cost of a qualified blood test is covered in full by Part B, as long as the laboratory performing the test is a Medicare-approved facility. The cost of the blood test will be applied to your annual Part B deductible, which is $185 in 2019.
If the laboratory is not Medicare-approved, there may also be a coinsurance payment required by the beneficiary.
A Medicare Supplement Insurance plan (also called Medigap) can help cover some of the cost of blood tests by providing coverage for certain Medicare out-of-pocket costs, such as deductibles and coinsurance.
Medicare Supplement Insurance plans can also cover the first three pints of blood used for a transfusion, which is not covered by Original Medicare.
Some of the more common types of blood tests that are covered by Original Medicare include:
Did you know that there may be Medicare Advantage plans available where you live that may help cover blood tests better than Original Medicare?
Learn more about the plans that may be available in your area by speaking with a licensed insurance agent at TTY Users: 711 24 hours a day, 7 days a week.
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