Medicare · Coverage
Does Medicare cover blood tests?
Last reviewed October 29, 20264 min readBy the Goodsurance editorial team Reviewed by the Goodsurance editorial team
Medicare usually pays the full cost of blood tests your doctor orders. That makes lab work one of the few things in Medicare that often costs you nothing. But there are limits on how often, and routine blood work with no medical reason is not covered. Here is what is free, what is not, and how a bill can show up.
Blood tests Medicare covers
Part B covers diagnostic lab tests. These are tests your doctor orders to find, rule out, or keep track of a health problem. They include many blood tests, urine tests, and tests on tissue samples.
The test must be medically necessary. That means your doctor orders it because of a symptom, a condition, or a treatment you are on. Medicare calls it reasonable for your health.
For most of these tests, you pay nothing for the lab work itself.
Free screening blood tests, and how often
A screening test looks for a problem before you have symptoms. Part B covers these blood tests at no cost if your provider accepts assignment. Assignment means they take Medicare's approved amount as full payment.
- Cholesterol and other blood fats: once every 5 years.
- Diabetes (blood sugar or A1C): up to 2 times a year if you are at risk. Examples are high blood pressure, obesity, or a history of high blood sugar.
- Prostate cancer (PSA): once every 12 months for men over 50.
- Hepatitis C: once in your life if you were born from 1945 to 1965. Once a year if you still inject illegal drugs.
- HIV: once a year if you are 15 to 65, or older if you are at higher risk.
- Colon cancer blood test: once every 3 years if you are 45 to 85 and at average risk. See our colonoscopy page for the other choices.
In short: a cholesterol check every 5 years and several other screening blood tests cost you nothing.
What Medicare does not cover
- Routine blood work with no medical reason. A yearly blood panel just to check is not covered unless it is one of the screenings above.
- Extra cholesterol checks. Medicare's rule says a cholesterol test in a person with no symptoms counts as screening, even with risk factors like family history. Outside the 5 year screening, Medicare pays only when you have a diagnosis or are on treatment.
- Tests done more often than the rules allow. For example, if your diabetes is under control, Medicare's rule says an A1C test more than every 3 months is not needed. Your doctor must document a reason for more.
A yearly wellness visit can help you plan which screenings you need. See our wellness visit page.
How a bill can show up
- The doctor visit. The lab test may be free, but the visit where your doctor orders it usually costs 20% of the approved amount after the $283 Part B deductible (2026). A yearly wellness visit costs nothing if your provider accepts assignment.
- A warning form from the lab. If the lab thinks Medicare will not pay, it may ask you to sign an Advance Beneficiary Notice (form CMS-R-131). If you sign it and Medicare says no, you pay the full cost. Ask why before you sign.
- A lab that does not take Medicare. Ask before your blood is drawn.
- If you have a Medigap plan: every plan pays some or all of your 20% share for the visit.
- If you have Medicare Advantage: check your plan's Evidence of Coverage for lab network rules.
- If you have Medicaid too: Medicaid may pay your share. Ask your state Medicaid office.
In short: the lab work is usually free; the visit, a signed warning form, or an out of network lab is where costs come from.
How to get blood work covered, step by step
- Get the order from your doctor. Medicare pays for lab tests a provider orders, not tests you order on your own.
- Ask what the test is for. If it is a screening, ask if you are due for it.
- Use a lab that takes Medicare. Ask first.
- Read any form before you sign it. A signed warning form means you agree to pay if Medicare says no.
- Check your Medicare Summary Notice. If a test was denied and you think it should be paid, you can appeal. The notice tells you how.
Common questions about Medicare
Quick answers, fast .
Tap any question to expand. Each links to a fuller standalone answer.
Does Medicare pay for routine blood work?
Not by itself. Medicare pays for blood tests your doctor orders for a medical reason, and for certain screenings like cholesterol every 5 years. A routine yearly panel with no reason is not covered.
How often does Medicare pay for cholesterol tests?
As a screening, once every 5 years at no cost. If you have high cholesterol or take medicine for it, Medicare pays for tests your doctor orders to track it, often once a year.
Do I pay anything for lab work with Medicare?
You usually pay nothing for Medicare-covered lab tests. You may pay for the doctor visit, or the full cost if you signed a warning form and Medicare denied the test.
How often does Medicare pay for an A1C test?
To screen for diabetes, up to 2 times a year if you are at risk. If you have diabetes that is under control, Medicare's rule says about every 3 months. More often needs a reason from your doctor.
References
- Medicare.gov, Diagnostic laboratory testsWhat lab tests Part B covers and what you pay.
- Medicare.gov, Cardiovascular disease screeningsCholesterol and blood fat tests every 5 years.
- Medicare.gov, Diabetes screeningsWho qualifies for blood sugar screening and how often.
- CMS, National Coverage Determinations 190.21 and 190.23 (lab tests)Medicare's limits on A1C and cholesterol testing.
- CMS, Advance Beneficiary Notice of Non-coverage (form CMS-R-131)The form a lab gives you when it expects Medicare to say no.