Does Medicare Cover Blood Work and Lab Tests?
Key Takeaways
- Medicare pays for diagnostic lab tests during a hospital stay or an outpatient visit.
- Medicare pays for an annual wellness visit, but not routine blood work.
- You can get regular screenings for specific conditions if you meet Medicare’s eligibility requirements.
- Medicare Advantage plans may offer more coverage than Original Medicare.
Is routine blood work covered by Medicare? The answer depends on the reason for your blood work. Medicare covers blood work and lab tests as long as they’re medically necessary to diagnose or monitor a health condition. Medicare won’t cover routine blood work at an annual physical, but you may be eligible for regular screenings for specific conditions. This article explains how Medicare covers blood tests, eligibility requirements for screenings, and potential costs.
How Blood Tests Monitor Your Health
Blood testing is often the first step in diagnosis — it’s minimally invasive but reveals a lot about a person’s overall health. Depending on the type of test, medical labs might measure an individual’s amount of blood cells, electrolytes, proteins, minerals, or hormones. These tests can detect health conditions like heart disease, diabetes, organ damage, and cancer, which are all easier to treat and manage with early detection.
Getting routine blood work or scheduled screenings helps establish a baseline that alerts doctors to potential issues sooner. For example, if your blood indicates high cholesterol, you can make lifestyle changes to prevent potential diabetes. Blood work also helps monitor treatment effectiveness. Since blood work is a key part of your overall health plan, knowing which tests Medicare will pay for is important.
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How Medicare Covers Blood Work and Labs
Original Medicare covers medically necessary lab work, which means your doctor has ordered the test to diagnose or monitor a health condition. Each test has different criteria for coverage and different coverage frequencies, though. For example, while you can get a diabetes screening twice per year if you meet eligibility criteria, you can only get a colorectal cancer screening every three years even if you meet eligibility requirements.
Medicare covers screenings under Medicare Part A and Part B. Medicare Part A covers blood work and lab testing done as an inpatient in a hospital, skilled nursing facility, or hospice facility. Lab work would be considered medically necessary in this setting to diagnose or monitor your health.
Medicare Part B covers outpatient procedures and preventative care, including blood tests and lab work at a doctor’s office. For example, if you go to urgent care to address an issue, your outpatient diagnostic tests would be covered under Medicare Part B. Medicare also pays for lab work to monitor whether your treatment is effective.
Routine vs. Medically Necessary
Prior to joining Medicare, you may have received routine blood work as part of your annual physical. This blood panel screens for various conditions, even if you are not at risk for anything in particular.
Original Medicare doesn’t cover testing in the same way. It does not cover generalized routine blood testing, only medically necessary blood tests. For example, if your doctor prescribes blood work because you exhibit symptoms of a specific condition and the blood work can help with diagnosis, this is considered medically necessary.
Part B covers an annual wellness visit, allowing you to discuss routine lab work and screening options with your doctor. However, the doctor’s recommendation doesn’t guarantee Medicare will pay for those tests. You still have to meet each test’s eligibility requirements for coverage.
Common Screening Blood and Lab Tests Covered by Medicare
As long as it is deemed medically necessary, these are the common tests that Medicare will cover:
- Basic metabolic panel: This measures eight substances in the blood, including glucose, calcium, sodium, and chloride to indicate kidney health, blood sugar levels, and fluid and electrolyte levels.
- Comprehensive metabolic panel: This test measures six additional substances in your blood. It can detect various conditions, including liver and kidney health, and measure treatment responsiveness.
- Blood enzyme test: Elevated enzyme levels can indicate heart damage, liver disease, organ failure, or other musculoskeletal diseases.
- Lipoprotein panel: This blood test measures the amount of lipids, or fats, in the blood. It can indicate high cholesterol and risk of cardiovascular disease.
- Tissue specimen test: Also known as a biopsy, this test requires removing a piece of tissue to diagnose cancer or other skin conditions.
- Urinalysis test: Urine samples help monitor kidney and liver health, urinary tract infections, and diabetes.
How Often Will Medicare Pay For Blood Work and Labs?
If your doctor orders diagnostic tests during a hospital stay or outpatient visit, Medicare will help cover the cost. Medicare pays for preventative screenings at different frequencies outside of diagnostic tests, depending on your eligibility.
- Diabetes screening (blood glucose test): Twice per year
- Cardiovascular disease screenings: Once every 5 years
- Colorectal b cancer blood-based biomarker screening: Once every 3 years
- HIV screening: Once per year if you meet the requirements
- Sexually transmitted infection screening: Once per year
Does Medicare Cover LabCorp or Quest Lab Testing?
Yes, as long as your doctor and the lab facility both accept Medicare, Medicare will pay for your covered tests. LabCorp and Quest Diagnostic operate thousands of locations across the U.S., so double-check that your specific facility accepts Medicare.
How Medicare Advantage Covers Blood Work and Labs
Labwork may be covered differently if you have Medicare Advantage, also known as Medicare Part C. Medicare Advantage plans are offered by private insurance companies and bundle Part A and Part B benefits, often with additional benefits beyond Original Medicare.
Medicare Advantage plans must cover as much as Original Medicare, including medically necessary lab work. Your exact coverage depends on your specific plan and provider.
Unlike Original Medicare, most Medicare Advantage plans use a healthcare provider network. If you get testing from in-network doctors and labs, your costs are lower. Some plans allow you to get out-of-network testing at a higher cost, while others won’t cover those tests at all. Additionally, your plan might require a referral before paying for any tests. When in doubt, contact your plan to check whether your doctor, labs, and tests are covered.
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How Much Blood Work Costs With Medicare
Lab testing usually falls under Medicare Part B. Even if your tests are medically necessary and covered by Medicare, though, you may have other costs to consider.
- Premium: The standard Part B premium is $185 in 2025. This is the amount you pay each month to keep your plan active. Medicare Advantage plans may have an additional premium.
- Deductible: You have to meet your Part B deductible of $257 in 2025 before Medicare starts to pay. Medicare Advantage plans may set their own deductibles.
- Copay and coinsurance: When you get lab work done, you may have to pay your doctor and the facility a set dollar amount (copay) or percentage (coinsurance). If you have Medicare Advantage, your portion of the cost will be higher for out-of-network care or not covered at all.
- Maximum out of pocket: Original Medicare doesn’t have an out-of-pocket maximum, which caps your out-of-pocket spending on covered benefits. Medicare Advantage has a cap. In 2025, you won’t pay more than $9,350 for covered care through Medicare Advantage though some plans may have lower out-of-pocket maximums.
Without Medicare, lab testing varies in cost, depending on how many tests you need and what facility you visit. Blood panels cost $6-$66 each on average without insurance for the most basic tests. Individual blood test costs can add up quickly.
Other Benefits to Consider
Beyond lab testing, Medicare covers other services that contribute to early detection and prevention.
- Welcome to Medicare Exam: Medicare covers a preventative visit within your first year of enrollment. This visit includes a vision test, depression screening, and height and weight measurements. You’ll get referrals for other care, plus a recommended list of screenings and immunizations to complete.
- Annual Wellness Visit: After your first year, you’re eligible for an annual visit. This isn’t a physical, though, and it doesn’t include routine blood work. Similar to the Welcome to Medicare Exam, this is an opportunity to check in with your doctor about your overall well-being and standard health markers.
- Common screenings: In addition to the blood work and lab tests mentioned above, Medicare also covers screenings for breast cancer, lung cancer, osteoporosis, and glaucoma if you meet eligibility criteria.
Putting It All Together
Medicare covers medically necessary lab work and blood tests, including some preventative screenings at set frequencies. However, it doesn’t cover routine or annual blood work. Knowing the difference between routine and medically necessary can help you make more efficient use of your Medicare benefits.
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Sources
- Preventative & Screening Services. Medicare.gov
- Insurance List. LabCorp.
- Urinalysis. Mayo Clinic.
- Ensure Quality Testing Without Disruption for Medicare Patients. Quest Diagnostics.