Does Medicare Cover Blood Tests?

• by Christian Worstell
• August 2, 2023
• Reviewed by John Krahnert

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.

What part of Medicare covers blood tests?

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 other benefits that are not covered by Original Medicare and are unique to each plan.

Or call 1-800-557-6059 (TTY: 711) to speak with a licensed insurance agent. We accept calls 24/7!

How much does a blood test cost?

If conducted in an inpatient care setting, the cost of the testing is subject to the Medicare Part A deductible, which is $1,600 per benefit period in 2023.

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 $226 in 2023.

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.

Common blood tests covered by Medicare

Some of the more common types of blood tests that are covered by Original Medicare include:

• Diabetes – Two screenings per year with a referral or by meeting qualifying risk factors (blood sugar test strips for people with diabetes are also covered by Part B)
  
  
• Prostate cancer – One screening per year as recommended by a doctor
  
  
• Cardiovascular disease – One test every five years as ordered by a doctor
  
  
• Hepatitis C – A one-time screening plus additional annual tests for those deemed at a higher risk
  
  
• Sexually Transmitted Infections – One screening per year

Medicare Advantage plans cover blood tests

Learn more about how Medicare Advantage plans can cover your blood tests and may also offer benefits that aren't covered by Original Medicare.

Or call 1-800-557-6059 (TTY: 711) to speak with a licensed insurance agent. We accept calls 24/7!

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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