At some point, you may need answers to some pressing medical questions. To figure out what’s happening, your doctor may wish to run some diagnostic tests and scans. This news can be scary, especially since something like a CT scan can cost as much as about $5,000 depending on where you go. Having an idea of what diagnostic tests are covered Medicare can give you a little peace of mind.
Luckily, if you have Medicare, there’s a good chance it will cover your diagnostic tests, making these services more affordable for seniors who need them. In fact, depending on certain circumstances, these tests may be fully covered!
What is Medicare’s Coverage for Diagnostic Tests
Depending on where and how you get diagnostic tests, Medicare offers different levels of coverage. If you have Original Medicare, Medicare Part B may cover your diagnostic test or scan. The part of Original Medicare that covers your test also defines what you’ll pay for it.
When Does Medicare Part B Cover Diagnostic Tests?
In order for Medicare Part B to help cover your diagnostic test, your primary care physician must sign off on it as medically necessary. If your test is a medically necessary clinical diagnostic laboratory test — like some blood tests or screenings — it will often be fully covered by Medicare.
For Medicare Part B to help cover your test, your doctor must sign off on it as medically necessary.
For diagnostic non-laboratory tests (e.g., X-rays, CT scans, MRIs, PET scans, EKGs), you’ll have to pay 20 percent of the Medicare-approved amount for the procedure if it’s done in an independent testing facility or your doctor’s office. You have to reach the Part B deductible first, however. If you receive this type of test at an outpatient department in a hospital (e.g., an emergency department or surgery center), you’ll owe a copayment.
When Does Medicare Part A Cover Diagnostic Tests?
In select cases, Medicare Part A may cover your diagnostic test. These situations are relatively rare because there’s only one circumstance when Part A may cover these tests — as part of medically necessary inpatient care. What makes this rare is that diagnostic tests are usually considered outpatient care, even if you’re staying at a hospital. This happens if inpatients are in observation status.
There’s only one circumstance when Part A may cover tests — as part of medically necessary inpatient care.
In order for Medicare Part A to help cover your diagnostic tests, your primary care physician must formally order the inpatient care and the hospital must admit you. Once this happens, diagnostic scans should be considered part of your inpatient care and covered as such. You will still have to reach your Part A deductible, though.
Can You Get Extra Coverage?
There are additional ways that you can cut your out-of-pocket costs for Medicare-covered services like diagnostic tests. The two most common options are Medicare Supplement plans or Medicare Part C (Medicare Advantage) plans.
Medicare Supplements, sometimes called Medigap plans, are privately-offered, Medicare-approved plans that pair with and “supplement” Original Medicare coverage. How can a Medicare Supplement help make diagnostic tests more affordable? Currently, every Medigap plan offers at least some coverage of Part B coinsurances and copayments. If you enrolled in either Medicare Supplement Plan C or F before the 2020 cutoff, you’ll have your Medicare Part B deductible covered as well!
Medicare Advantage, or Medicare Part C, plans can also offer coverage for diagnostic tests. Medicare Advantage plans are an alternative to Original Medicare offered by private companies that are approved by the Centers for Medicare and Medicaid Services. How much you’ll pay for each diagnostic service varies from plan to plan, so you’ll need to look at your specific plan to find out. In many cases, you’ll need prior authorization before getting approved for diagnostic test coverage as well.
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Diagnostic tests can be essential to answering important questions about your health and connecting symptoms together to form a diagnosis. With the assistance of your Medicare plan, these tests can be both attainable and affordable if you need them!
If you’re curious about finding additional coverage for diagnostic tests or a plethora of other services, check out the Medicareful Plan Finder. It can show you Medicare Advantage, Part D, and Medicare Supplement plans nearby and help you get in contact with a licensed sales agent if you need help.