Original Medicare covers medically necessary blood tests. Medicare Advantage offers at least the same coverage. If a person needs multiple laboratory tests, they may need to pay for part of the cost.
Original Medicare, which includes Part A and Part B, covers blood tests when a doctor orders them. Medicare Advantage, which is the alternative to Original Medicare, offers at least the same coverage.
Outpatient blood tests and diagnostic screenings are covered by Medicare Part B, and out-of-pocket costs will typically apply.
Out-of-pocket costs may also apply to Medicare Advantage plans.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Part B covers most medically necessary blood tests and other diagnostic tests. To qualify, a person’s doctor must write an order for the test.
If an individual is admitted to a hospital as an inpatient, Medicare Part A will cover the costs of blood work.
Medicare Advantage, or Medicare Part C, is an alternative to Original Medicare. Private insurers administer Medicare Advantage plans, and the plans comprise parts A and B benefits and often also include prescription drug coverage and additional benefits like optical or dental care.
Like parts A and B, Medicare Advantage plans cover the costs of blood work and other tests.
If a person with Original Medicare goes to a Medicare-approved lab, they will typically pay nothing for most diagnostic tests.
However, there may sometimes be some out-of-pocket costs. For a diagnostic test, such as an X-ray, an individual will still pay 20% of the cost. The 2025 Part B annual deductible of $257 also applies.
To help with the cost of Medicare services, people with Original Medicare have the option of buying a Medigap plan, which is Medicare supplement insurance, from a private insurer.
Medigap plans can help cover the costs of:
- copayments
- deductibles
- coinsurance
A person must have both Part A and Part B to qualify for a Medigap plan. They cannot get Medigap if they have Medicare Advantage.
A person with Medicare Advantage may be responsible for copayments and coinsurance. These costs vary among plans. Someone with a Medicare Advantage plan may also need to visit an in-network laboratory to ensure lower out-of-pocket costs.
Medicare covers most diagnostic, doctor-ordered blood tests, including the following.
Complete blood count
A complete blood count helps detect clotting problems, immune system disorders, blood cancers, and blood disorders such as anemia.
Blood chemistry test
The blood chemistry test, also called a basic metabolic panel (BMP) test, usually measures components of the fluid portion of the blood. These measurements give doctors information about how the muscles, bones, and certain organs — such as the kidneys — are working.
BMP tests determine calcium, glucose, and electrolyte levels. These are essential minerals that maintain fluid levels.
Blood enzyme tests
Enzymes are responsible for chemical reactions in the body. Some tests may measure enzymes that indicate that a person has had a heart attack. Medicare will usually cover such tests.
For example, one of these enzymes, called troponin, is a muscle protein that increases when an injury occurs in heart cells. In turn, this creates kinase, which is a blood product that the body releases when an injury occurs in the heart muscle.
Lipoprotein panel
Medicare covers a lipoprotein panel every 5 years. This test helps determine whether a person is at risk of heart disease.
Thyroid-stimulating hormone test
High levels of thyroid-stimulating hormone, which is made in the brain, indicate that the thyroid gland is not making enough hormones. Low levels of this hormone indicate that the gland is making too much. Medicare coverage usually applies under Part B.
Thyroid hormones should be within a certain range for the optimal regulation of body temperature, weight, and muscle strength.
When a person gets a checkup, a doctor may order laboratory tests other than standard blood tests. Medicare usually covers these tests. They may include the following.
Urinalysis
Urinalysis checks the acidity, color, and appearance of urine. It also measures substances not usually present in urine, such as blood and bacteria.
This test helps doctors diagnose urinary tract infections, diabetes, and kidney infections.
Fecal occult blood test
Medicare covers a fecal occult blood test once every 12 months for people ages 45 years or above.
The test checks for blood in the stool that a person cannot see with the naked eye. If the result is positive, it may indicate that some part of the digestive tract is bleeding. The bleeding may be due to many causes, such as ulcers or abnormal growths called polyps.
Pap test
Medicare generally covers Pap tests every 2 years for females, though some situations may require more frequent tests. For example, if a person had an abnormal Pap test in the previous 3 years and is of child-bearing age or at high risk of certain cancers, Medicare covers a Pap test once per year.
The test allows doctors to look for changes and precancerous cells in the cervix, which is the lower end of the uterus. An anomaly may suggest the presence of cells that could develop into cervical cancer.
Prostate-specific antigen test
Medicare covers prostate-specific antigen tests yearly for males ages 50 years and older.
Prostate-specific antigen is a protein made by both healthy and cancerous cells of the prostate gland. Levels are often high in people with prostate cancer.
Original Medicare (parts A and B) covers medically necessary blood tests. Usually, a person does not need to pay for a diagnostic blood test. However, the plan deductible and 20% coinsurance may apply.
People with Original Medicare may choose to purchase a Medigap plan, which is Medicare supplement insurance, to help with out-of-pocket costs.
Medicare Advantage plans also cover blood tests, and coinsurance and copayments may apply. A person may also need to use specific in-network laboratories.
