Medical testing is a routine part of maintaining one’s health. More often than not, the first line of screening for signs of disease or infection may include lab work using blood samples or other bodily fluids. Today’s advanced medical testing equipment and techniques can identify the cause of many diseases using less blood than ever before. Not only does this reduce discomfort for patients, it also allows for faster and more effective treatment. Common lab work may reduce the need for more invasive diagnostic procedures and expensive scanning tests that often require arduous preparation by the patient.
Does Medicare Cover Lab Work?
When ordered by a physician, lab work is generally covered by Medicare Part B. Part B (Medical Insurance) helps cover medically necessary services and care in an outpatient setting, such as a doctor’s office. In order to be covered by Part B, you will need to visit a Medicare-approved physician who accepts assignment and orders the tests in response to diagnose, treat or monitor a condition.
Because of this, lab work that is sought out on your own will likely not be covered. There are many independent labs available that provide a number of the same tests that doctors routinely order, but if you seek out these services on your own, you’ll have to pay out of your own pocket. An exception to this may be when a doctor has ordered lab work at a facility that you aren’t able to access. If a closer alternative is available that can provide the same tests according to your doctor’s orders, then you may be able to appeal.
Individuals enrolled in a Medicare Advantage plan will have at least the same coverage as Medicare Part A and Part B, but many MA plans include additional benefits. Check you’re your specific plan to find out more details regarding lab work coverage.
Does Medicare Cover Lab Work in a Hospital?
If you’re formally admitted to a hospital or skilled nursing facility, your services will usually be covered by Medicare Part A (Hospital Insurance). While in a hospital, you will likely need to receive lab testing in order to stabilize, diagnose or treat a condition. If you need to have lab work done after being released from a hospital or medical facility to follow up from your surgery or illness, then Medicare Part B will likely cover the expenses as long as you meet the criteria and visit Medicare-approved facilities.
Do Medicare Deductibles Apply to Lab Work?
You will likely be responsible for your annual deductible under Part A and Part B for most lab work services. Any type of medical billing to your Medicare coverage plan may count against your deductible. Medicare Part A and Part B both have different deductible amounts that may change annually. If you have Original Medicare and have purchased a Medicare Supplement (Medigap) policy, your policy may help cover the costs that Original Medicare does not, such as deductibles, copayments, or coinsurance.