It's the truth that most people don't want to face. But when you get older, you need to pay more attention to your body and lifestyle. And regular blood testing is one of the more effective ways to help you monitor health and catch diseases early. So the question many elderly Americans have is: are these tests covered under Medicare, the Federal Government-funded program set up to make healthcare more affordable for them?
The good news is Medicare does provide coverage for many common blood tests and screenings. And in this guide, we will walk you through all the details about how these tests are covered under Original Medicare (Medicare Part A and Part B) and Medicare Advantage plans (Part C).
Why Do I Need Blood Tests?
Blood tests are one of the best ways for your doctor to check on your health and catch any issues early on. Whether you use clinical laboratory tests, tissue specimen tests, or simple at-home tests, it is important to get your blood work done on a routine basis. And here are why:
- To Screen for Diseases: Blood tests can detect early signs of serious diseases like diabetes, heart disease, thyroid disease, and even certain cancers. Early detection of these diseases is critical to successful treatment and management.
- To Monitor Conditions: If you have an ongoing health condition like diabetes, high blood pressure or high cholesterol, blood tests are used to monitor your levels and make sure any treatments are working effectively. Blood tests also help your doctor determine if adjustments to your medications or treatment plan are needed.
- To Check Vitamin and Mineral Levels: Blood tests assess levels of essential nutrients in your body like iron, vitamin B12, vitamin D, and folic acid. Deficiencies in these vitamins and minerals can lead to health issues, so blood tests help make sure you have adequate levels.
- To Evaluate Organ Function: Blood tests check on the health of your major organs like your kidneys, liver, and thyroid. By measuring levels of certain substances in the blood, your doctor can see how well your organs are functioning and check for any signs of damage or impaired performance.
Main Types of Blood Tests And What They Measure
What types of blood tests are available? Here's a guide to help you understand the most common blood tests and what they measure.
- Complete Blood Count: A complete blood count or CBC measures your red and white blood cell counts, hemoglobin, and hematocrit. Red blood cells carry oxygen, so lower counts can indicate anemia. White blood cells fight infection, so higher counts may mean you have an infection.
- Cholesterol Levels: High cholesterol raises your risk of heart disease, so your doctor will check your total cholesterol along with LDL (bad) cholesterol and HDL (good) cholesterol. LDL should be below 100 for most adults, while HDL should be 60 or higher. High triglycerides, another type of fat in your blood, also increase heart disease risk.
- Blood Glucose: Your blood glucose or blood sugar level measures how well your body uses insulin to convert the food you eat into energy. Higher-than-normal blood sugar could indicate prediabetes or diabetes. Fasting blood sugar should be below 100 for most non-diabetic adults.
- Liver and Kidney Function: Tests like ALT, AST, and creatinine measure how well your liver and kidneys are working. Abnormal levels could indicate a liver or kidney condition that requires treatment.
- Thyroid Stimulating Hormone (TSH): TSH measures how well your thyroid gland is functioning. Both low and high TSH levels can cause symptoms like fatigue, weight changes, and mood issues. Normal TSH for most adults falls between 0.5 to 5.0 mIU/L.
Some Basics about Medicare
So before we move onto more details about Medicare blood test coverage, here're a few important definitions of Medicare terminology.
Medicare Parts A & B are called Original Medicare:
- Part A - is hospital insurance for long- term inpatient hospital stays, hospice care, stays in skilled nursing facilities, and home health care.
- Part B - is regular medical insurance for medical equipment, home health care, outpatient care, doctor visits and visits from other healthcare providers, and preventative services.
- Part C - is also called Medicare Advantage. Medicare Advantage is simply a Medicare-approved private company plan that gives you a different option for your drug and health coverage. These plans also have extra benefits that are not included in Original Medicare, (Parts A & B). Some of these benefits include:
- Dental services
Which Parts of Medicare Cover Blood Tests And Screenings
Medicare Part B covers blood testings ordered by a physician and which are administered in a doctor's office or in an outpatient clinical setting. Some typical conditions covered include
- Diabetes screening tests
- Hepatitis B & C (for high risk individuals)
- Colorectal cancer (a fecal occult blood test screening if the individual is 50 or older and has a doctor referral)
- Prostate cancer (for men over 50)
- Various sexually transmitted diseases (chlamydia, syphilis, Hepatitis B and gonorrhea)
- COVID-19 antibody test
Medicare Part A also covers blood testing when they are done in a hospital or skilled nursing facility setting. These often take place during an individual's temporary stay while recovering from surgery or after an emergency.
Does Medicare Advantage Cover Additional Tests and Blood Work?
In short, yes — many Medicare Advantage plans provide coverage for important blood tests and health screenings beyond what Original Medicare offers. For example, some plans may include blood glucose testing for diabetes management, cholesterol testing to monitor heart health, or cancer screenings like prostate-specific antigen (PSA) tests or colonoscopies.
The specific extra benefits offered will depend on the individual Medicare Advantage plan. It’s a good idea to compare plans in your area to see what blood work and screening options they provide. Some plans may charge small copays for these additional services, while others may offer them at no extra cost as part of your plan benefits. Either way, taking advantage of preventive care and health screenings is an important step towards maintaining your overall well-being as you get older.
Where Can You Get Blood Work Done?
Getting your blood work done d is easy—you have a few convenient options:
Your primary care doctor can draw blood samples in their office and send them to a lab for screening and analysis. This is a familiar and comfortable choice for many.
Walk-in clinics like Quest Diagnostics and LabCorp also offer blood testing services on a first-come, first-served basis. No appointment is needed, but you may have to wait during busy times. These clinics have locations nationwide, so you're likely to find one nearby.
Some diagnostic centers provide mobile blood testing where a lab technician will come directly to your home or workplace to draw and collect samples. This can be ideal if mobility is an issue or you have a busy schedule.
Certain screening tests like cholesterol, blood glucose, and basic metabolic panels only require a small blood sample obtained from a simple finger prick. Blood test kits done at home provide the necessary materials to collect fingerstick blood samples, which are then mailed into a lab. This do-it-yourself method offers privacy and convenience without leaving home.
Does Medicare Cover Any Other Diagnostic Tests?
In addition to blood tests, you're probably wondering what other types of tests are covered by your insurance. Well, Medicare covers a variety of diagnostic blood tests to help your doctor check for health issues or monitor certain conditions.
X-rays use radiation to create images of your internal organs, bones, and tissues. Medicare covers x-rays for things like chest imaging, abdominal scans, and bone scans.
EKG or ECG
An EKG checks your heart rhythm and electrical activity. Doctors often order EKGs if you're having symptoms like chest pain, palpitations, or shortness of breath to check for any heart abnormalities.
CT and MRI scans
CT scans combine multiple x-rays to create cross-sectional images of your body. MRIs use magnetic fields to create virtual images. Medicare covers CT scans and MRIs for examining organs, blood vessels, and tissues in your chest, abdomen, pelvis.
A colonoscopy allows your doctor to check for polyps or cancer inside your colon and rectum. Medicare covers regular colon cancer screenings for those ages 50-75.
How to Find a Medicare Plan With The Best Blood Test Coverage
If you want to get routine blood work done in addition to the medically necessary blood tests, then perhaps you should look beyond the Original Medicare. But note that every Medicare Advantage plan is different, and it would involve a lot of work to find one that both offers comprehensive Medicare coverage and suits all of your other needs.
Our goal at EASY Insurance is to help you do exactly that. We are a team of experienced insurance agents that are dedicated to helping you find the Medicare plan of your dreams. Whether your need is best served by an Original Medicare plan or a Medicare Advantage plan, we're happy to take the time to discuss what you want out of your healthcare plan.
We're here for you and can't wait to help you live your most comfortable and EASY life!
Let's chat today at 888-212-7991.