Does Medicare Cover Bloodwork and Lab Tests?

Medicare, a federal health insurance program, provides coverage for millions of Americans, primarily those aged 65 and older, along with certain younger individuals with disabilities. This program helps beneficiaries manage healthcare costs, encompassing various medical services. This article clarifies how different parts of Medicare address coverage for bloodwork and lab tests, which are frequent components of medical care.

Coverage Under Medicare Part B

Medicare Part B covers outpatient bloodwork and lab tests. This includes diagnostic blood tests deemed medically necessary by a doctor to diagnose, monitor, or treat a medical condition. “Medically necessary” means the tests are appropriate and required for the diagnosis or treatment of an illness or injury, or to improve the functioning of a malformed body member. For example, Part B covers tests like blood chemistry panels to check organ function, complete blood counts to assess for blood disorders, and lipoprotein panels for cholesterol levels.

Part B also covers certain preventive screenings that involve bloodwork, such as cardiovascular disease screenings, diabetes screenings for individuals at risk, and HIV screenings. Routine or experimental blood tests not considered medically necessary are typically not covered. For covered services, beneficiaries are usually responsible for the Part B annual deductible, which is $257 for most people in 2025, followed by a 20% coinsurance of the Medicare-approved amount.

Coverage Under Medicare Part A

Medicare Part A primarily provides coverage for inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Bloodwork and lab tests are covered under Part A only when performed as part of a covered inpatient stay in a hospital or another facility. This means any necessary blood tests conducted during a formal hospital admission fall under Part A coverage.

Coverage Under Medicare Part C (Medicare Advantage)

Medicare Part C, also known as Medicare Advantage, offers an alternative to Original Medicare through private insurance companies approved by Medicare. These plans are legally required to cover at least all the services that Original Medicare covers, which includes medically necessary bloodwork and lab tests. However, Medicare Advantage plans often have their own specific rules, costs, and networks.

Beneficiaries enrolled in a Medicare Advantage plan might need to obtain prior authorization for certain tests or be required to use specific laboratories or providers within the plan’s network. Out-of-pocket costs, such as copayments or coinsurance, can vary depending on the specific plan chosen. Reviewing your plan’s summary of benefits is important to understand bloodwork coverage details.

Coverage Under Medicare Part D

Medicare Part D provides coverage for prescription drugs. Part D generally does not cover diagnostic blood tests or lab work. While Part D may cover certain medications that require periodic blood monitoring, the actual blood test itself is not covered by Part D. Its function is limited to pharmaceutical expenses, not diagnostic services.