Blood Tests Medicare Does Not Cover

What blood tests Medicare DOES cover (and at what cost)

Medicare Part B covers medically necessary diagnostic laboratory tests — including many blood tests, urinalysis, and tissue specimen tests — but only when your health care provider orders them and you use a Medicare-accredited lab. For these covered diagnostic tests, you usually pay nothing: no copay and no deductible.

The key word is 'diagnostic.' Medicare law limits coverage to items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury. If you have signs, symptoms, a complaint, or a relevant history, your doctor can order a blood test to investigate it, and Medicare generally pays.

A separate, short list of preventive blood screenings is also covered by law even when you have no symptoms — but each has its own eligibility rules and frequency limit (see the next section).

Blood tests Medicare does NOT cover

The most common reason a blood test is denied is that it counts as 'screening' rather than 'diagnostic.' Tests performed in the absence of any signs, symptoms, complaints, or personal history of disease are not covered unless a specific federal law authorizes that particular screening. This is why a doctor's order alone does not guarantee payment — the order must be tied to a covered medical reason or an authorized screening benefit.

• Routine annual blood work / general 'wellness' panels with no symptoms or covered diagnosis — Medicare has no benefit for routine yearly blood draws just to check that everything looks normal.
• Blood screenings done more often than the law allows (for example, a cholesterol/lipid panel sooner than once every 5 years).
• Routine vitamin D level checks — vitamin D testing is NOT a listed Medicare preventive screening and is covered only when a provider orders it as medically necessary to diagnose or treat a specific condition.
• Pre-symptomatic genetic tests and tests used to detect an undiagnosed disease or a predisposition to disease — generally not a Medicare benefit.
• Exams and tests required by a third party — an employer, an insurance company, a business, or a government agency — are not covered.
• Any test from a lab that is not Medicare-accredited.

Covered preventive blood screenings and their frequency limits

A handful of blood screenings are covered even without symptoms, but only within strict limits. Going beyond the allowed frequency, or not meeting the eligibility criteria, means Medicare will not pay and you would owe the cost. You generally pay nothing ($0) for each of these when it is covered and the provider accepts assignment.

• Cardiovascular disease screening (cholesterol, lipid, and triglyceride levels): covered once every 5 years. Want it more often without a covered diagnosis? You pay out of pocket.
• Diabetes screening (fasting/non-fasting glucose, A1C, or other Medicare-approved glucose tests): covered up to 2 times per year for at-risk patients. Screenings beyond that limit are not covered.
• Prostate cancer PSA blood screening: covered once every 12 months for men age 50 and older (starting the day after the 50th birthday). A more frequent preventive PSA is not covered.
• Hepatitis C screening: covered only if a primary care provider orders it and you meet specific conditions — yearly if you are high-risk (such as past or present illicit injection drug use), or once if you were born from 1945 through 1965 and are not high-risk. Outside these conditions it is not covered.

Why you got a bill, and what an ABN is

If a lab or provider believes Medicare is likely to deny a blood test — because it exceeds a frequency limit, lacks a covered diagnosis, or is a screening not authorized by law — they must give you an Advance Beneficiary Notice of Non-coverage (ABN, Form CMS-R-131) before doing the test. The ABN explains why Medicare probably won't pay and estimates the cost.

If you sign the ABN and choose to proceed, you accept financial responsibility and will probably have to pay if Medicare denies the claim. Importantly, if you were NOT given an ABN before a test that Medicare then denies, you may not have to pay for it. Always read an ABN carefully before signing.

This is the usual reason a test you expected to be 'free' shows up as a bill: it fell outside Medicare's coverage rules, and you (or someone on your behalf) signed an ABN agreeing to pay.

What you'll pay, and how to appeal a denial

For a blood test Medicare does not cover, you pay the lab's full charge out of pocket. For any associated diagnostic services that are not part of the $0 lab benefit, standard Part B cost-sharing applies: in 2026 you first meet the $283 annual Part B deductible, then pay 20% coinsurance of the Medicare-approved amount.

If you believe a test should have been covered, you have the right to appeal. Follow the instructions on your Medicare Summary Notice (MSN), go to Medicare.gov/appeals, or call 1-800-MEDICARE. An appeal can succeed if, for example, the test was actually tied to a covered diagnosis but was coded or documented incorrectly.

Plan type can also matter. Medicare Advantage plans must cover at least what Original Medicare covers but set their own networks and rules, so confirm details in your plan's Evidence of Coverage. A Medigap (Medicare Supplement) policy only helps pay costs for services Original Medicare itself covers — it generally will not pay for a test Medicare denies outright.