Top Blood Tests Medicare Won’t Pay For (And Why)

As of 2025, Medicare continues to play a critical role in providing healthcare coverage for seniors and individuals with certain disabilities. While Medicare covers a wide array of diagnostic and preventive services, many beneficiaries still ask the crucial question: What blood tests does Medicare not cover? Understanding which tests are covered and which are not can help seniors avoid unexpected bills and manage their health more effectively.

In this article, we’ll walk you through:

• The scope of Medicare blood test coverage

• Which blood tests Medicare does not cover

• Why are certain tests excluded

• How to appeal denied claims

• Alternative ways to pay for non-covered tests

• And much more.

Let’s break it down step-by-step for easy understanding.

Understanding Medicare Coverage for Blood Tests in 2025

Medicare is divided into parts, each offering specific coverage:

• Part A covers inpatient hospital services.

• Part B covers outpatient care, including lab tests.

• Part C (Medicare Advantage) is an alternative that may offer expanded coverage.

• Part D focuses on prescription drugs.

Under Medicare Part B, diagnostic blood tests are generally covered when ordered by a doctor for a medically necessary reason. This includes tests used to:

• Diagnose or monitor a disease

• Assess organ function

• Screen for certain conditions (like diabetes, cholesterol, or anemia)

What Types of Blood Tests Are Covered by Medicare?

Medicare will usually cover the following routine blood tests:

• Complete Blood Count (CBC)

• Basic Metabolic Panel (BMP)

• Comprehensive Metabolic Panel (CMP)

• Lipid Panel

• Thyroid function tests

• Blood glucose testing

• HbA1c tests for diabetes

• Liver function tests

• Renal (kidney) function tests

Coverage is contingent on the test being deemed medically necessary by a healthcare provider.

What Blood Tests Does Medicare Not Cover?

Here’s the focus of our article: What blood tests does Medicare NOT cover? Although Medicare covers many tests, it does not cover everything. The following are commonly excluded from Medicare coverage in 2025:

1. Routine Screening Without Symptoms or Risk Factors

If your doctor orders a test just to “check things out” and you have no symptoms or diagnosis, Medicare may deny coverage. Examples:

• Annual cholesterol checks without risk factors

• Vitamin or mineral level tests (e.g., Vitamin D, B12) for routine screening

• Antibody testing without exposure or symptoms

2. Experimental or Investigational Tests

Any lab test that hasn’t received FDA approval or isn’t widely accepted as standard care may not be covered. This includes:

• Emerging cancer marker panels

• Certain advanced genetic testing

• Non-FDA-approved diagnostic panels

3. Nutritional and Micronutrient Testing

Tests like the following are generally not covered unless medically justified:

• Vitamin B1, B6, B12 (if not showing deficiency symptoms)

• Folate

• Magnesium

• Selenium

• CoQ10 levels

• Omega-3 index tests

4. Hormone Panels Without Medical Justification

Many seniors seek hormone testing for wellness, aging, or vitality, but Medicare doesn’t cover:

• Testosterone levels without a diagnosis

• Cortisol testing for general fatigue

• Full hormone panels for anti-aging

5. Anti-Aging and Functional Medicine Tests

Tests used in integrative or functional medicine are usually not covered, including:

• Food sensitivity tests

• Environmental toxin screens

• Adrenal fatigue panels

• Heavy metal tests (unless toxicity is suspected)

6. Direct-to-consumer or At-Home Blood Tests

If you order your own test without a doctor’s order or use an at-home kit, Medicare won’t cover the cost. This includes:

• DNA health tests (23andMe-style)

• Mail-in blood sugar or cholesterol checks

• Online wellness panels

Why Does Medicare Not Cover Some Blood Tests?

Medicare has specific guidelines to determine coverage based on medical necessity, evidence-based practice, and cost-effectiveness.

Here are the primary reasons:

1. Lack of Medical Necessity

Medicare only pays for services that are considered necessary to diagnose or treat a medical condition. If the test doesn’t directly relate to a documented medical issue, it will likely be denied.

2. Preventive vs. Diagnostic Confusion

If a test is done for preventive screening and not due to a health issue or risk factor, it may not be covered unless it falls under Medicare’s preventive services list.

3. Insufficient Clinical Evidence

Some lab tests are new or not yet supported by enough research to be considered standard care. Medicare won’t cover tests that fall into this category.

4. Provider or Lab Not Enrolled in Medicare

Even if the test is typically covered, it will be denied if performed by a lab or provider not enrolled with Medicare.

How to Know If a Blood Test Will Be Covered

Before getting any lab work done, ask your healthcare provider:

• Is this test medically necessary?

• Will Medicare cover this?

• What diagnosis code will be used for billing?

You can also ask your lab or clinic to perform a Medicare coverage determination in advance.

What Happens If Medicare Denies the Blood Test?

If Medicare denies your claim, you have several options:

1. Appeal the Decision

You can submit an appeal with a letter from your physician explaining why the test was necessary.

2. File a Reconsideration Request

This is a second-level review if the initial appeal is denied.

3. Advance Beneficiary Notice (ABN)

Before testing, the provider may give you an ABN form indicating the test may not be covered. You’ll have the option to agree to pay out-of-pocket if needed.

How to Pay for Non-Covered Blood Tests

If Medicare doesn’t pay for your test, you have several options:

1. Use a Medicare Advantage Plan

Some Part C plans offer broader lab coverage, especially those with wellness benefits. Check your plan’s summary of benefits.

2. Use Discount Lab Services

Online companies like Ulta Lab Tests, QuestDirect, and Walk-In Lab offer deeply discounted testing.

3. Community Health Clinics

Federally funded health centers may provide blood work on a sliding scale or free of charge.

4. Health Savings Accounts (HSA) or FSAs

Though typically for those with high-deductible plans, these funds can be used for lab costs not covered by Medicare.

The Role of Medicare Advantage in Blood Test Coverage

Medicare Advantage plans often offer expanded preventive services. Some may include:

• Annual wellness lab panels

• More comprehensive hormone testing

• Nutritional assessments

However, coverage varies widely by provider and region, so always check your plan’s documents.

Tips to Avoid Unexpected Lab Costs

• Get Prior Authorization: Check with your doctor and the lab to confirm if prior approval is required.

• Review the ABN: Understand your financial responsibility before the test.

• Ask for CPT Codes: These codes help determine whether the test is covered.

• Keep Copies of Medical Records: If you need to appeal, documentation helps.

• Stick to Medicare-Approved Labs: Not all labs bill Medicare correctly.

What Are the 6 Things Medicare Doesn’t Cover?

Besides some blood tests, here are six other categories of services Medicare doesn’t typically cover:

1. Long-term custodial care (nursing home stays)

2. Routine dental care

3. Hearing aids and exams

4. Routine vision care

5. Cosmetic procedures

6. Acupuncture and holistic services (with some exceptions)

FAQs

How often will Medicare pay for blood tests for seniors?

Medicare covers medically necessary blood tests as often as needed, but frequency depends on the specific test and condition. Some screenings like cholesterol may be covered once every 5 years, while HbA1c for diabetes may be covered multiple times per year.

What are the six things Medicare doesn’t cover?

Medicare does not cover:

1. Long-term care

2. Dental services

3. Hearing aids

4. Vision care

5. Cosmetic surgery

6. Some preventive and holistic treatments

Which blood tests are not covered by Medicare?

Medicare doesn’t cover:

• Vitamin and mineral panels without deficiency symptoms

• Hormone tests not linked to a medical diagnosis

• Anti-aging or wellness panels

• At-home and direct-to-consumer tests

• Experimental lab tests

Why does Medicare not cover some blood tests?

Because they are either not considered medically necessary, lack strong evidence, or are requested for general wellness rather than diagnosing or treating a specific condition.

Final Thoughts

Blood tests are a critical part of health maintenance and disease detection, especially for seniors. However, understanding what blood tests Medicare does not cover in 2025 is crucial to avoid unexpected medical bills. While Medicare provides generous lab coverage for tests deemed medically necessary, it does not cover routine, experimental, wellness, or at-home tests without a medical diagnosis.

By staying informed, speaking with your provider, and exploring your Medicare plan’s details, you can navigate coverage rules more effectively. And if you need additional tests outside Medicare’s scope, alternative options like discount labs, community clinics, and Medicare Advantage plans may help you bridge the gap.

Always remember to advocate for your health—knowledge is the best defense against surprise expenses.

Looking for Medicare made easy? Start with a free quote at NewMedicare.com or dial 📞 (833) 203-6742!

Katelin Young

With a genuine passion for Medicare and healthcare, I become a dedicated and informed writer. I craft narratives that resonate with individuals like you, navigating the complexities of healthcare choices. Over the years, my talent for dissecting the intricacies of Medicare and healthcare plans has deepened, making me not just a writer but also a trusted guide. I'm here to empathize with you as you explore your healthcare options. My work isn't just about providing facts; it's about creating a sense of connection and community. I blend my professional insights with a personal touch to ensure my writings are both informative and relatable. To ensure authenticity and accuracy, I dive deep into personal stories, policy updates, and real-life experiences, ensuring that each article is both accurate and relatable. Please note I'm AI-Katelin, an AI-enhanced writer. Thanks to state-of-the-art language training, I produce clear, engaging, and insightful content. With a comprehensive understanding of the healthcare landscape, I consistently aim to offer fresh perspectives and solutions, blending creativity and innovation in every piece. Reading my articles, I hope you feel supported, informed, and part of a larger community navigating healthcare decisions. I intend to assure you that you're not alone in your Medicare journey. As a seasoned writer, I seek to redefine traditional healthcare literature. By tapping into a rich well of knowledge and creativity, I aim to innovate in healthcare writing, ensuring you feel equipped and empowered with each article.

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