Does Medicare Pay for Your A1C Test?
Navigate Medicare coverage for your A1C test. Learn about eligibility, test frequency, out-of-pocket costs, and plan differences.
The A1C test, also known as the hemoglobin A1C or HbA1c test, is a common blood test that provides an overview of a person’s average blood sugar levels over the past two to three months. This test measures the percentage of hemoglobin in red blood cells that is coated with sugar. It is used for diagnosing diabetes and pre-diabetes, and for monitoring diabetes management.
A1C Test Coverage Under Original Medicare
Original Medicare Part B (Medical Insurance) covers A1C tests under various circumstances. Historically, coverage was primarily for monitoring diagnosed diabetes, but expanded in 2024 to include screening for pre-diabetes and type 2 diabetes.
For individuals diagnosed with type 1 or type 2 diabetes, Part B covers the A1C test when ordered by a healthcare provider as medically necessary to manage their condition. The A1C test provides a comprehensive picture of glucose levels, unlike single readings that only show a snapshot.
Medicare Part B also covers A1C tests for screening if a healthcare professional determines an individual is at risk for developing diabetes. Risk factors include high blood pressure, high cholesterol or triglyceride levels, or obesity. Individuals aged 65 or older, those who are overweight, or those with a family history of diabetes may also be eligible.
The A1C test does not require fasting, which can be a barrier for some patients seeking other blood glucose tests. This facilitates earlier detection of pre-diabetes and diabetes. All A1C tests, whether for diagnosis, monitoring, or screening, must be medically necessary and ordered by a licensed healthcare provider to be covered by Medicare.
Frequency of A1C Test Coverage
The frequency at which Medicare covers A1C tests depends on an individual’s medical status and risk factors. For beneficiaries diagnosed with diabetes, Medicare Part B covers the A1C test every 90 days, or approximately four times a year. This helps healthcare providers monitor treatment plans and make necessary adjustments.
For individuals at high risk for developing diabetes or diagnosed with pre-diabetes, Medicare Part B covers A1C tests for screening up to two times within a 12-month period. This expanded coverage, effective from 2024, simplifies diabetes screening frequency.
Previously, distinctions in screening frequency based on a prior diagnosis of pre-diabetes existed, but these have been simplified. Current guidelines allow for two screenings within a year for all Medicare beneficiaries at risk for diabetes. This ensures that individuals with elevated risk can be regularly monitored for changes in their blood sugar levels.
Beneficiary Costs for A1C Tests
When A1C tests are covered under Original Medicare Part B, out-of-pocket costs for beneficiaries vary depending on the test’s purpose. For preventive screening for those at risk of diabetes, Medicare waives both coinsurance and the deductible. Beneficiaries generally pay nothing for these tests if their provider accepts Medicare assignment.
If the A1C test is ordered for diagnostic purposes or to monitor an existing diabetes diagnosis, it is considered a diagnostic laboratory service. The standard Medicare Part B deductible applies. For 2025, the Part B deductible is $257. After meeting this annual deductible, Medicare pays 80% of the Medicare-approved amount.
The beneficiary is responsible for the remaining 20% coinsurance. Clinical laboratory services, such as A1C tests, generally do not have a separate copayment. Individuals with Medicare Supplement Insurance (Medigap) plans may find their out-of-pocket costs, including the Part B deductible and coinsurance, are reduced or fully covered, depending on their specific plan. State Medicaid programs can also help cover these costs for eligible low-income beneficiaries.
Medicare Advantage Plans and A1C Tests
Medicare Advantage Plans, also known as Medicare Part C, are offered by private insurance companies approved by Medicare. These plans are legally required to cover at least all the benefits that Original Medicare covers, including A1C tests. Therefore, if an A1C test is covered under Original Medicare, it will also be covered by a Medicare Advantage Plan.
While coverage for A1C tests is guaranteed, the cost-sharing structure can differ significantly from Original Medicare and vary based on the specific plan chosen. Medicare Advantage plans may have their own copayments, coinsurance, and deductibles for services, even for laboratory tests like the A1C. These costs are set by the individual plan and can be different from the Part B deductible and 20% coinsurance of Original Medicare.
Many Medicare Advantage plans operate with network restrictions, meaning beneficiaries may need to use doctors, laboratories, and other providers within the plan’s network for services to be covered. Using out-of-network providers could result in higher out-of-pocket costs or no coverage. Beneficiaries should consult their specific plan documents or contact their plan provider directly to understand the coverage, cost-sharing, and network requirements for A1C tests.