Medicare insurance provides access to medically necessary clinical diagnostic laboratory tests that are either routine or necessary in emergencies. This coverage is available for Medicare beneficiaries who are enrolled in Original Medicare (Parts A and, or B) or a Medicare Advantage (Part C) plan. This benefit includes lab tests such as blood tests, urinalyses, tissue specimen exams, and certain preventive and screening tests.
Diagnostic laboratory tests are invaluable tools for physicians because they can show changes in health conditions, help them diagnose or rule out illnesses or medical conditions, aid in the early detection of disease for more effective treatment, and to aid in disease prevention.
If your health care provider orders lab tests, Medicare typically covers 100 percent of the cost, but you’ll need to know where you can have them done to be eligible for this coverage.
What lab should you use to get Medicare coverage for your tests?
As mentioned above, if your Medicare-affiliated health care provider orders medically necessary clinical diagnostic laboratory tests, Medicare covers them. However, where you go for your lab tests depends on what type of plan you have. Here’s a breakdown of how the different parts of Medicare cover lab tests:
Original Medicare Part A (hospital insurance)
When you’re an inpatient in a hospital that accepts Medicare assignment and your physician orders lab tests during your stay, Medicare Part A covers the cost for these tests that are done in the hospital laboratory.
Under Original Medicare Part A, you must pay the deductible for the benefit period to cover your inpatient hospital stay whether you have lab tests or not.
Original Medicare Part B (medical insurance)
When you are an outpatient and your Medicare-affiliated health care provider orders medically necessary clinical diagnostic lab tests, Original Medicare Part B covers 100 percent of the cost for these approved tests.
To be eligible for this benefit, you must use a laboratory that accepts Medicare assignment. If your physician doesn’t do the testing in his office, he can suggest a lab for you, or you can use one that you prefer if it accepts Medicare. The types of labs that Medicare insurance typically covers include:
- Physicians’ offices
- Hospital labs
- Independent labs
- Nursing facility labs
- Labs in other institutions like long-term care, etc.
If you’d like a more comprehensive list of Medicare-affiliated laboratories in your service area, you can contact CMS for assistance.
Medicare Advantage (Part C)
All Medicare Advantage plans are required to provide the same (at minimum) benefits that Original Medicare Parts A and B do, so your lab tests should be covered if you’re eligible. However, depending on the type of Part C plan you have, your provider may require that you use network providers and facilities for your health care services.
By using network providers, medical facilities, and laboratories, your provider can control health care costs. So, you might need to have your tests done at a specific lab to get your coverage.
If you aren’t sure which laboratories you can use in your service area, you should ask your health care provider for information, or contact your plan provider to get details before making appointments.