Send FeedbackAging 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.
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:
| Test | Who is covered | How often | Description |
|---|---|---|---|
| Abdominal aortic aneurysm screening |
|
Once in a lifetime |
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| Alcohol misuse screenings and counseling | Adults who use alcohol but don’t meet the medical criteria for alcohol dependency | Once every 12 months |
|
| Bone mass measurements | Any patients who meet at least one of the following conditions:
|
Once every 24 months |
|
| Cardiovascular disease screenings | Everyone | Once every five years | Includes tests for:
|
| Colonoscopies | Everyone age 45 or older | Once every 24 months if high risk for colorectal cancer |
|
| Colorectal cancer screenings | Everyone age 50 or older | Once every 48 months depending on risk factors and last colonoscopy |
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| Depression screenings | Everyone | Once every 12 months |
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| Diabetes screenings | Patients who are at risk according to their doctor | Up to two screenings per year depending on risk factors |
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| Glaucoma tests | Patients who are high risk for developing glaucoma | Once every 12 months |
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| Hearing and balance exams | Patients whose doctors order these tests to see if medical treatment is needed | Once every 12 months |
|
| Hepatitis B virus (HBV) infection screenings | Patients at high risk for HBV infections or pregnant people | Once a year | If you are pregnant, Medicare covers these screenings |
| Hepatitis C screening test | Patients with a doctor’s order or high risk |
|
You may be considered high risk:
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| HIV screening | Patients between the ages of 15 and 65 and patients at increased risk for HIV | Once a year | If you’re 15 to 65 or at an increased risk of HIV, you can get HIV screening once per year — or three times during pregnancy. |
| Mammograms (screening) | Patients assigned female at birth who are 40 or older | Once a year | If medically necessary, diagnostic mammograms may be performed more frequently but may be subject to deductible and copay |
| Obesity screenings and counseling | Patients with a body mass index (BMI) of 30 or more | As determined by your doctor | A BMI screening will be performed followed by behavioral and dietary counseling |
| Prostate cancer screenings | Patients assigned male at birth who are over the age of 50 | Once every 12 months |
|
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.
Featured Expert
This expert contributed information and recommendations for this guide.
Karen Cavasini-Esch, Medicare consultant
Sources
- Medicare Preventive Screening Services | Last accessed January 2023
- Medicare, Is Your Test or Service Covered? | Last accessed January 2023
- Medicare | Medicare Advantage Plans | Last accessed January 2023
- Medicare Costs | Last accessed January 2023
