Medicare Covered Testing
Aging into Medicare on your 65th birthday is a rite of passage for many older adults—one that means navigating the system, selecting supplemental coverage in many cases, and understanding what Medicare does and does not cover. For some, Medicare is confusing, but the good news is it is also very comprehensive and covers most medically necessary tests a doctor would order, says insurance advisor Karen Cavasini-Esch, who’s been helping adults with Medicare and related plans since 1985.
“Almost everything I can think of testing-wise is covered, but tests must be prescribed,” Cavasini-Esch says. “Not knowing what preventive and health tests are available and covered could prevent some seniors from getting the tests they need. Or, if a test requires a co-pay that feels burdensome for those on a fixed income, older adults on Medicare could put off a lab test or screening. “Unfortunately, the bad things that happen to people healthwise tend to happen over the age of 65, so Medicare is highly utilized.”
How can you use Medicare for medical tests and screenings? This comprehensive resource lists all health tests and preventive screenings covered by Medicare so you can maximize your benefits.
I. Which Tests Does Medicare Cover?
Medicare has two parts: Part A and Part B. In general, Part A covers inpatient hospital care, skilled nursing facility care, nursing home care that is not custodial or long-term, hospice care, and home health care. Part B covers medically necessary services to diagnose or treat medical conditions; and preventive services. Part B can cover clinical research, ambulance services, durable medical equipment, mental health, limited outpatient prescription drugs. Part B covers health tests and screenings, including lab tests, X-rays, and bloodwork.
The easiest way to find out which tests Medicare covers is to use Medicare’s simple search tool that allows you to type in the type of test to get information on whether it falls under Part B.
Here is a comprehensive list of all tests and screenings that Medicare Part B covers:
- Abdominal aortic aneurysm screening
- Alcohol misuse screenings & counseling
- Barium enemas
- Blood sugar monitors
- Blood sugar test strips
- Bone mass measurements
- Cognitive assessment & care plan services
- Colorectal cancer screenings
- Coronavirus disease 2019 (COVID-19) antibody test
- Coronavirus disease 2019 (COVID-19) tests
- Depression screenings
- Diabetes screenings
- Diagnostic laboratory tests
- Diagnostic non-laboratory tests
- EKG or ECG screenings
- Eye exams (for diabetes)
- Eye exams (routine)
- Glaucoma tests
- Hearing & balance exams
- Hepatitis B Virus infection screenings
- Hepatitis C screening test
- HIV screening
- Mammograms (screening)
- Mental health & substance use disorder services
- Multi-target stool DNA tests
- Obesity screenings & counseling
- Prostate cancer screenings
- Screening fecal occult blood tests
- Screening flexible sigmoidoscopies
- Sexually transmitted infection screenings & counseling
- Sleep studies
II. How Medicare Covers Testing
Medicare covers many tests and services based on where you live, and the tests we list in this guide are covered no matter where you live. There are some limitations to tests, such as “once in a lifetime” for an abdominal aortic aneurysm screening or every 12 months for mammogram screenings. Medicare will explain all costs for testing and screenings so you understand your responsibility. For example, for a mammogram, you will be responsible for paying 20% of the Original Medicare amount. Medicare has specific pricing for each of its preventive screenings and health tests. Some adults choose a Medicare Advantage Plan or Supplement to further defray the cost of healthcare, including screenings.
“Medicare covers about 80% of what can ever happen, and the 20% that is not covered is why people buy a supplement or Advantage plan,” Cavasini-Esch says. “Most supplements cover 100% with a few deductibles or copays, and any of the Advantage plans can be free, which is very attractive to people who are on a fixed income.”
As for time limits, Cavasini-Esch reminds that Medicare-covered health tests and screenings require a prescription. Prescriptions do not last forever, so be sure to check to see when the prescription expires and get your test before that deadline.
Following is a chart including all Medicare-covered health tests and screenings, what’s covered, how to qualify, test frequency, and out-of-pocket costs.
III. Featured Expert
This expert contributed information and recommendations for this guide.
Karen Cavasini-Esch, Medicare consultant