Does Medicare Pay for Routine Blood Work?
Unravel Medicare's rules for blood test coverage. Learn when tests are covered, your costs, and how to ensure your lab work is paid for.
Routine blood work typically refers to general blood tests performed as part of a regular check-up, even without specific symptoms or medical concerns. Understanding Medicare’s specific rules for blood work coverage is important for beneficiaries.
Medicare’s Criteria for Blood Work Coverage
Medicare generally covers blood tests that are considered medically necessary. This means a healthcare provider has ordered the tests to diagnose a specific condition, monitor an existing illness, or guide treatment decisions. For instance, if a patient presents with symptoms that suggest a particular health issue, blood tests to investigate those symptoms would typically fall under medical necessity.
Blood tests performed solely for general wellness or as part of a routine annual physical without a specific medical indication are generally not covered by Medicare. While Medicare does offer an Annual Wellness Visit, this appointment focuses on creating a personalized prevention plan and does not include routine blood work.
Commonly Covered Blood Tests
Medicare Part B covers a wide range of diagnostic blood tests when they are medically necessary and ordered by a physician. Examples include a complete blood count (CBC) to check for conditions like anemia, blood glucose tests for diabetes management, or cholesterol panels when medically indicated for heart disease monitoring.
Medicare also covers specific preventive and screening blood tests, even without symptoms, under certain conditions and frequencies. For instance, screenings for cardiovascular disease, including cholesterol, lipid, and triglyceride levels, are covered once every five years. Diabetes screenings are covered up to twice per year for individuals at high risk, while prostate-specific antigen (PSA) tests for prostate cancer screening are covered annually. Other covered screenings may include tests for colorectal cancer, HIV, and hepatitis B and C, each with specific eligibility criteria and frequencies.
Understanding Your Costs
For most covered blood tests under Medicare Part B, beneficiaries are typically responsible for some out-of-pocket costs. After meeting the annual Part B deductible, which is $257 in 2025, the beneficiary generally pays 20% of the Medicare-approved amount for the service. This coinsurance applies to diagnostic lab work performed on an outpatient basis.
However, certain preventive services, including some specific screening blood tests, are covered at 100% by Medicare Part B. For example, cardiovascular screening blood work or the annual PSA blood test are often covered without cost-sharing. Medicare Supplement (Medigap) policies can help cover some of these out-of-pocket expenses, such as deductibles and coinsurance, while Medicare Advantage plans may have different cost-sharing structures.
Ensuring Your Blood Work is Covered
To help ensure your blood work is covered, it is important to have tests ordered by a Medicare-approved doctor. The tests should also be performed at a Medicare-approved laboratory or facility. Discussing the purpose of the tests with your doctor beforehand can clarify if they are considered medically necessary or a covered preventive screening.
If a healthcare provider believes Medicare may not cover a specific blood test, they should provide an Advance Beneficiary Notice of Noncoverage (ABN) form. This document informs you that Medicare is likely to deny payment and explains that you will be responsible for the cost if you choose to proceed with the test. Reviewing the ABN and discussing it with your provider or the lab before the test can help you make an informed decision and understand potential financial liabilities.