Medicare covers most blood tests ordered by your doctor, but you pay a share of the cost

Medicare Part B covers blood tests when your doctor orders them as part of your medical care. You do not pay anything for the test itself if your doctor uses a lab that accepts Medicare. What you pay depends on whether you have met your deductible and which type of Medicare plan you have. Some blood tests are covered in full; others require you to pay a percentage of the cost after you meet your annual deductible.

The key is that Medicare decides whether a test is medically necessary based on your symptoms and medical history, not on your request alone. A routine blood test during a physical exam is usually covered. A blood test your doctor orders to monitor a chronic condition like diabetes is usually covered. A blood test you request for general wellness that your doctor does not order is usually not covered.

Key Takeaways

  • Medicare Part B covers blood tests ordered by your doctor when medically necessary, with no charge for the test itself if you use an in-network lab.
  • You pay your Part B deductible (currently $240 per year) before Medicare begins to pay, and then you typically pay 20 percent of the cost.
  • Preventive blood tests like cholesterol screening and diabetes screening are covered in full with no copay or coinsurance if done during a covered preventive visit.
  • If you have a Medicare Advantage plan, your copay or coinsurance for blood tests may differ, and you should check your plan documents or call your plan.
  • Using an out-of-network lab can result in higher costs, so ask your doctor which lab accepts Medicare before your test.

How Medicare Part B covers blood tests

When your doctor orders a blood test, Medicare Part B pays for it if the test is considered medically necessary. Medically necessary means your doctor has a clinical reason to order it — to diagnose a condition, monitor an existing condition, or rule out a disease based on your symptoms or risk factors. Medicare does not cover blood tests ordered purely for curiosity or general wellness screening that your doctor does not recommend.

The lab that performs the test must be enrolled in Medicare and accept Medicare payment. Most hospitals, urgent care centers, and independent labs do. If your doctor sends your blood to a lab that does not accept Medicare, you may owe the full cost. Before your test, ask your doctor or the lab whether they accept Medicare.

Medicare pays the lab directly. You do not pay the lab upfront and then seek reimbursement. The lab bills Medicare, and Medicare pays its share. You pay your share at the time of the test or receive a bill afterward, depending on the lab's billing process.

What you pay out of pocket

Your out-of-pocket cost depends on whether you have Original Medicare (Part A and Part B) or a Medicare Advantage plan, and whether you have met your deductible for the year.

With Original Medicare Part B, you pay a yearly deductible before Medicare starts to pay. Once you meet the deductible, you typically pay 20 percent of the Medicare-approved cost of the test. The remaining 80 percent is paid by Medicare. If you have a Medigap supplemental insurance plan, it may cover some or all of your 20 percent coinsurance, depending on which Medigap plan you have.

With a Medicare Advantage plan, you pay a copay or coinsurance amount set by your plan. This amount varies by plan and by lab. Some plans charge a flat copay (for example, $10 or $25 per test). Others charge a percentage of the cost. You should check your plan's summary of coverage or call your plan to find out what you will pay for blood tests.

Preventive blood tests covered in full

Medicare covers certain preventive blood tests at no cost to you. These tests are part of your covered preventive services and do not require you to pay a deductible or coinsurance. The tests must be done during a covered preventive visit, and your doctor must order them as part of preventive care, not to diagnose or treat a specific condition.

Covered preventive blood tests include screening for high cholesterol (lipid panel), screening for diabetes (fasting glucose or A1C), and screening for colorectal cancer using a blood-based test if your doctor orders one. Screening for hepatitis B and hepatitis C is also covered for certain age groups or risk factors. A one-time screening for abdominal aortic aneurysm using an ultrasound is covered for men ages 65 to 75 who have ever smoked.

The difference between a preventive test and a diagnostic test matters. If your doctor orders a cholesterol test because you have symptoms of heart disease or a family history of high cholesterol, it may be considered diagnostic rather than preventive, and you may owe cost-sharing. If your doctor orders it as part of a routine preventive screening, you pay nothing.

Diagnostic blood tests and cost-sharing

When your doctor orders a blood test to diagnose or monitor a specific condition, it is considered diagnostic. You pay cost-sharing for diagnostic tests. Common diagnostic blood tests include tests to check thyroid function, liver function, kidney function, blood sugar levels in people with diabetes, and tests to diagnose infections or anemia.

For each diagnostic test, you pay 20 percent of the Medicare-approved cost after you meet your Part B deductible. If the test costs $100 and Medicare approves $80, you pay $16 (20 percent of $80). If you have not yet met your deductible, you pay the full approved cost up to your deductible amount, then 20 percent after that.

Some people have multiple blood tests ordered at the same time. Each test is billed separately, and you pay cost-sharing for each one. If your doctor orders a panel of tests (for example, a comprehensive metabolic panel that includes multiple measurements), Medicare may bundle them into one charge, but you still pay 20 percent of that bundled charge.

Using in-network and out-of-network labs

Medicare does not have a formal "network" of labs the way Medicare Advantage plans do, but it does have approved labs that accept Medicare. When you use an approved lab, your cost is limited to your deductible and coinsurance. When you use a lab that does not accept Medicare, you may owe the full cost.

Some labs are owned by hospitals, some are independent, and some are part of large national chains. Your doctor usually chooses the lab, but you can ask your doctor to use a specific lab if you have a preference. Before your test, confirm with the lab that it accepts Medicare and that it is in-network for your plan if you have a Medicare Advantage plan.

If you receive a bill from a lab for more than your expected cost-sharing, contact the lab and Medicare to find out why. You may have been charged by an out-of-network provider, or there may be a billing error.

How to find out what your blood test will cost

Before your blood test, you can get an estimate of what you will pay. Ask your doctor's office which lab will perform the test and whether it accepts Medicare. Then call the lab and ask for an estimate based on your Medicare coverage. Tell them whether you have Original Medicare or a Medicare Advantage plan, and whether you have met your deductible for the year.

The lab can tell you the Medicare-approved cost and what your share will be. If you have a Medicare Advantage plan, call your plan to confirm your copay or coinsurance for that specific lab. If you have Original Medicare, you can also call Medicare at 1-800-MEDICARE to ask about coverage for a specific test.

Keep in mind that estimates are not guarantees. Your actual bill may differ if the lab discovers that additional testing is needed or if the test is coded differently than expected. If your bill is higher than the estimate, ask the lab to explain the difference.

Frequently Asked Questions

Does Medicare cover blood tests during a routine physical?

Yes, if your doctor orders blood tests as part of a covered preventive physical exam, those tests are covered in full with no copay or coinsurance. If your doctor orders additional diagnostic tests during the same visit because of a specific concern, you pay cost-sharing for those additional tests.

What if my doctor orders a blood test but I do not think it is necessary?

You can ask your doctor why the test is being ordered and discuss whether you want to proceed. If you decide not to have the test, tell your doctor and the lab. Medicare will not charge you for a test you do not have. If you have questions about whether a test is medically necessary, you can contact Medicare at 1-800-MEDICARE.

Will I owe money if the lab bills Medicare and Medicare denies the test?

If Medicare denies the test as not medically necessary, the lab should not bill you for it. The lab is required to inform you before the test if there is a chance Medicare will not cover it. If you receive a bill after a denial, contact the lab and ask them to appeal or to remove the charge.

Does Medicare cover blood tests ordered by a nurse practitioner or physician assistant?

Yes, blood tests ordered by a nurse practitioner or physician assistant who is working within a medical practice are covered the same way as tests ordered by a doctor. The provider must be authorized to order tests, and the test must be medically necessary.

Can I get a blood test without a doctor's order?

Medicare does not cover blood tests you order for yourself without a doctor's order. Some labs offer direct-to-consumer blood tests that you can order and pay for out of pocket, but Medicare will not pay for these. If you want a blood test covered by Medicare, your doctor must order it.