Routine tests are a fundamental part of preventive care and health management. However, additional screenings and lab work may be ordered by your physician if deemed medically necessary. Different medical conditions and some lifestyle factors can contribute to low vitamin D levels in the body. Medicare insurance may cover additional tests to determine or monitor deficiency for some situations.

Benefits of Vitamin D

The primary function of vitamin D in the body is to contribute to bone strength and density. Because vitamin D helps your body absorb calcium, you need it to prevent your bones from becoming fragile or softening.

Reports from the Mayo Clinic note that vitamin D may also play a role in improving cognitive health, preventing certain cancers, and treating plague-type psoriasis in a topical preparation. Some studies also suggest that maintaining appropriate vitamin D levels can have a positive impact on mental health.

Most people gain enough vitamin D from exposure to the sun or from fortified foods. In cases where you have limited sun exposure or you may have other underlying health conditions that decrease your natural vitamin D levels, you may need to supplement.

Potential Risk Factors for Vitamin D Deficiency

If you experience medical conditions that prevent your body from processing vitamin D through sun exposure or diet, vitamin D deficiency can pose a major health risk. These conditions can include:

  • Crohn’s disease
  • Celiac disease
  • Nutrient absorption issues related to gastric bypass surgery
  • Chronic kidney or liver disease
  • Hyperparathyroidism
  • Granulomatous disease
  • Sarcoidosis
  • Tuberculosis
  • Histoplasmosis

Medications that impact your body’s ability to metabolize vitamin D can also lead to health risks. Your physician or pharmacist can help you determine if you are experiencing a deficiency due to drug interactions.

Aging also changes how your skin absorbs sunlight and converts it into vitamin D, as well as your liver and kidneys’ ability to process vitamin D’s active form. Obesity can raise the risk of deficiency due to body fat preventing vitamin D from entering the bloodstream effectively.

Medicare Coverage for Vitamin D Testing

Generally, blood tests and screenings are performed as an outpatient procedure at your physician’s office or in a laboratory facility. These tests may be covered by Medicare Part B as long as you doctor orders the tests and deems them medically necessary. If you have Original Medicare, you will usually pay 20% of the cost of your services, and the Part B deductible will apply. However, standard blood tests may not include screening for vitamin D deficiency.

Unless your doctor indicates a test for vitamin D deficiency is medically necessary, Medicare insurance may not classify the test as qualifying for coverage. To be considered medically necessary, your physician may have to provide documentation of suspected symptoms of deficiency or proof of other medical conditions that are known to cause a deficiency.

Medicare Part B may also limit how many vitamin D tests can be performed during a certain period. This is typically determined by the nature of the deficiency and if appropriate supplementation is considered an adequate treatment. If an underlying medical condition is suspected to create a chronic deficiency, regular testing may be approved for coverage. Part B deductibles and yearly limits could apply.

Medigap or Medicare Advantage Plans may help reduce certain out-of-pocket costs. Medicare Advantage plans are required to cover the same Part A and Part B benefits as Original Medicare, but some Medicare Advantage Plans provide additional benefits, such as an allowance for certain over-the-counter products like vitamin D supplements. The benefits and costs offered by these plans vary, so check with your plan directly to review your specific coverage.

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