Medicare covers the lab
Does Medicare Cover Blood Tests?
Original Medicare, Part A and Part B, covers blood tests if a person's doctor orders one. Medicare Advantage, the alternative to Original Medicare, offers at least the same coverage
Original Medicare Part A and Part B cover blood tests if a person's doctor orders it. Medicare Advantage, the alternative to Original Medicare, offers at least the same coverage.
Someone on Genuine Medicare typically doesn't have a diagnostic blood test fee, while a person on a benefit plan may be responsible for co-payments.
Below, we examine Medicare blood test coverage and the associated costs. Then we define blood tests and discuss common laboratory tests that Medicare covers.
There may be some terms used in this article that can help you choose the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain period of time before an insurer begins to fund their treatments.
- Co-insurance: This is a percentage of the cost of treatment that a person will need to self-finance. For Medicare Part B this is 20%.
- Co-payment: This is a fixed dollar amount that an insured person pays for certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare coverage for blood tests and other laboratory work
Original Medicare includes Part A, Hospital Insurance, and Part B, Health Insurance.
Part A covers blood tests and other laboratory diagnostic tests that a doctor may order for a person to be hospitalized.
Part B covers outpatient laboratory diagnostic tests when a doctor considers them necessary, such as certain blood tests, tissue samples, a urinalysis, and some screening tests.
Medicare Advantage, the alternative to Original Medicare, also includes blood tests and other diagnostic laboratory tests.
Part D consists entirely of prescription drugs and therefore does not cover blood tests.
Medicare-covered laboratory test costs
Typically, when a person goes to a Medicare-approved lab on genuine Medicare, they won't pay anything for most diagnostic lab tests. However, there are exceptions when a person may have to pay part or all of the cost, e.g. For example, if a doctor orders a laboratory test more often than Medicare coverage allows, or if a doctor orders a laboratory test that Medicare does not cover.
For a diagnostic test such as X-rays, a person pays 20% of the cost. Part B's annual deductible of $ 198 also applies.
To reduce costs when medical tests are not covered by Medicare, those with original Medicare have the option of purchasing a Medigap plan, which is Medicare supplemental insurance.
Some Medigap plans cover all co-payments and co-insurance costs associated with Part B, while other Medigap plans only cover part of the costs.
A person with Medicare Advantage may be responsible for co-payments and co-insurance. These costs vary between plans. Someone with a benefit plan may also need to go to a lab on the network for a lower cost.
What are blood tests?
Blood tests help doctors diagnose conditions and conditions such as heart disease, cancer, and diabetes. These tests can show:
- How well do the organs such as the heart, kidneys and liver work?
- Heart disease risk factors
- how well the blood coagulates
- whether drugs work
Some tests do not require prior preparation; others require fasting for a certain number of hours.
During a blood test, a lab technician draws a small amount of blood, usually from a vein in a person's arm. The process takes a short time. While it can cause discomfort in the short term, most people will not experience serious reactions.
When doctors use blood test results to diagnose a condition after considering other information. This information includes a person's medical history, current symptoms, and vital signs such as pulse rate, blood pressure, and temperature.
What common blood tests does Medicare cover?
Medicare covers most diagnostic blood tests, such as:
Complete blood count
The complete blood count helps detect clotting problems, immune system disorders, blood cancer, and blood disorders such as anemia. It measures:
- Red blood cellsthat carry oxygen to all parts of the body
- White blood cellsthat fight infections
- Platelets, the fragments that cause blood to clot
- hemoglobin, the part of the red blood cells that carries oxygen
Blood chemistry test
The blood chemistry test, also known as the Basic Metabolic Panel (BMP), usually measures components of the liquid portion of the blood. These measurements give doctors information about how the muscles, bones, and certain organs such as the kidneys work.
BMP tests determine levels of calcium, glucose, and electrolytes, which are essential minerals that help maintain fluid levels.
Blood enzyme tests
Enzymes are responsible for chemical reactions in the body. Some tests can measure enzymes that indicate that a person has had a heart attack.
For example, one of these enzymes, troponin, is a muscle protein that increases when an injury occurs in heart cells. This in turn creates kinase, a blood product that is released when an injury occurs in the heart muscle.
Medicare covers a lipoprotein panel every 5 years. It helps show if people are at risk for heart disease. The panel measures:
- Total cholesterol, a fatty substance that can build up in the arteries
- Triglycerides, a kind of fat in the blood
- Low density lipoprotein, the main cause of a blockage in the arteries
- High density lipoproteinThis will help reduce artery blockage
Thyroid stimulating hormone test
High levels of thyroid-stimulating hormone made in the brain indicate that the thyroid is not making enough hormones, and low levels indicate that the gland is making too much.
Thyroid hormones should be within a certain range in order to optimally regulate body temperature, weight and muscle strength.
What other laboratory tests does Medicare cover?
When a person is examined, a doctor may order laboratory tests other than standard blood tests. Medicare usually covers these tests. They can include:
A urinalysis will check the acidity, color, and appearance of the urine. It also measures substances that are not normally found in urine, such as blood and bacteria. This test helps a doctor diagnose urinary tract infections, diabetes, and kidney infections.
Fecal occult blood test
Medicare covers a stool occult blood test every year for people 50 years and older. 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 part of the digestive tract is bleeding. The bleeding can be due to many causes, including ulcers or abnormal growth called polyps.
Medicare generally covers Pap tests for women every 2 years, although some situations may require more frequent testing. For example, if a person has had an abnormal Pap test in the past 3 years, and a person is of childbearing age or is at high risk for certain types of cancer, Medicare will cover a Pap test once a year.
The test allows the doctor to look for changes and precancerous lesions in the cervix, the lower end of the uterus. An abnormality may indicate the presence of cells that could develop into cervical cancer.
Prostate-specific antigen test
Medicare covers a prostate-specific antigen test for men aged 50 and over once a year. This is a protein made by both healthy prostate cells and cancer cells. It is often high in men with prostate cancer.
Original Medicare includes blood tests that are considered medically necessary. A person with this coverage usually pays nothing for most laboratory diagnostic tests. However, in some cases a person will have to pay 20% co-insurance and the Part B deductible will apply.
To pay for costs that are not covered, people with original Medicare can buy Medigap, a Medicare supplementary insurance.
Medicare Advantage also covers blood tests, but co-insurance and co-payments may apply. A person may also need to use labs on the network for a lower cost.
The information on this website can help you make personal decisions about insurance. However, they are not intended to be used as advice on buying or using any insurance or insurance product. Healthline Media does not conduct any insurance business and is not licensed as an insurance company or manufacturer in any US jurisdiction. Healthline Media does not recommend or endorse any third party who could conduct the insurance business.
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