Preventive vs diagnostic lab tests
The same blood test can be billed two ways, depending on why it was ordered:
- Preventive (screening): routine tests for people without symptoms or a diagnosis. Under the Affordable Care Act, most plans cover listed screenings at no cost in network. For adults these include cholesterol for certain ages or higher risk, type 2 diabetes for ages 40 to 70 who are overweight, hepatitis C for ages 18 to 79, and HIV for ages 15 to 65.
- Diagnostic: tests ordered because of symptoms, an abnormal past result, or to monitor a condition you have. These usually carry a copay, coinsurance or deductible.
This is why people get a bill after an annual physical: the visit is preventive, but if your clinician adds tests for a symptom or a known condition, those can be billed as diagnostic. HealthCare.gov notes that $0 preventive coverage doesn't apply in every case.
Why the lab's network status matters
Your plan's network is the labs, facilities and providers it has contracts with. Preventive $0 coverage generally applies only in network, and an out-of-network lab usually costs you more.
- Ask your clinician which lab your sample will go to.
- Check that lab is in network on your insurer's website or by calling the number on your card.
- Ask whether the test is billed as preventive or diagnostic, and what you'll owe after your deductible.
Does Medicare cover blood tests?
Medicare Part B covers medically necessary diagnostic lab tests your clinician orders, including certain blood tests, urinalysis and some tissue tests. You usually pay nothing for covered diagnostic lab tests. Medicare also covers some preventive screenings, such as diabetes, hepatitis B and C, HIV and cardiovascular screening blood tests.
Your clinician may suggest tests Medicare doesn't cover or covers only so often. Ask why and what you'd pay before agreeing.
When paying cash makes sense
If you have a high deductible, want a test your plan won't cover, or want to track markers more often, a cash price can cost less than billing insurance. If you're uninsured or choose to self-pay, you can usually ask for a good faith estimate before your test.
At Gabriel, a free account pays cost-plus prices on lab tests, and Gabriel Core and Plus members get member prices on lab tests. You can upload any lab report and Gabriel explains it free. Gabriel membership is not health insurance. See how much is a lab test and lab test near me.
Common questions
Why was I charged for blood work at my physical?
Some tests may have been billed as diagnostic, for a symptom or a condition you have, rather than as preventive screening. Ask your clinician's office how each test was coded and call your insurer if it looks wrong.
Does insurance cover blood work for routine checkups?
Listed preventive screenings, such as cholesterol and diabetes screening for eligible adults, are usually $0 in network. Other routine tests may count toward your deductible.
Does Medicare cover blood tests?
Yes, Part B covers medically necessary diagnostic lab tests your clinician orders, and you usually pay nothing for them.
Is it cheaper to pay cash for lab tests?
Sometimes, especially with a high deductible or for tests your plan doesn't cover. Compare your insurer's estimate with the cash price before you test.
How do I know if a lab is in network?
Check your insurer's online directory or call the number on your insurance card, and ask your clinician which lab will run the test.
Sources
- Diagnostic laboratory tests Medicare.gov
- Preventive care benefits for adults HealthCare.gov
- Preventive vs. diagnostic screenings Highmark
- Network (glossary) HealthCare.gov
- Preventive services coverage Centers for Medicare & Medicaid Services
- Your rights and protections against surprise medical bills Centers for Medicare & Medicaid Services
This guide is general information, not medical advice. It does not replace a visit with a licensed clinician. Gabriel membership is not health insurance.