Annual Blood work/Lab under Medicare - cost question

[rahaparta]

Before Medicare, I would typically have a fully covered (Blue Cross Blue Shield) typical blood lab (Quest Labs) where doctor faxed Rx to local lab, I would walk in for blood draw and have results via email 1 or 2 days later in my Inbox. Could discuss results with doctor (in person or phone) if wanted/needed.

No charge for any of this as it was coded "Annual wellcare/preventative healthcare".

Or I would opt to order a-la-carte from life extension annual blood draw sale, get 7 pages for couple hundred dollars and share (or not share) results with my personal doctor. Again, results via PDF file in email.

With Medicare, knowing there is a limit to how much lab can charge, it still looks to me like a "black box" as I can ask for my primary doctor to send Rx to Quest lab and they will bill Medicare and maybe 3 months later I will get a bill from Medicare for this annual blood work.

What is a typical Medicare billed Blood work/Lab charge for "normal/healthy" person, consisting of Lipid profile, Red and White blood cell analysis, Inflammation markers (C reactive protein, A1C etc) ?

$100, $200, $300 ?

Surely there exists some back-of-the-envelope stats on this ?

Not lab work ordered due to some onset of sickness but wellcare blood work.

Also, in case someone understands how this applies --- how is this page useful?-- what does this add to my original question?: https://www.medicare.gov/coverage/clinical-laboratory-tests

Someone reached out and added a caveat to my question: Assume person is only on original Medicare, that is has Medicare A and B and is not on any sort of Advantage plan which may have their own rules.

Having a Medigap (such as High Deductible plan G) has no effect on this in the context of annual preventative/pre-illness/wellness blood profile analysis.

[Dr Kidstache]

Perhaps your question is answered here: https://www.medicare.gov/coverage/preventive-screening-services     For example, as you can see from the link above under "cardiovascular disease screening", a lipid profile is covered every 5 years. Your "Welcome to Medicare" visit would address some of your questions about what preventative care is recommended for your age/risk group. It's entirely possible that you've been having lab work annually that isn't actually needed and/or recommended annually and so continuing to get extra labs wouldn't be covered as preventative services.

 

[rahaparta]

So, apparently nobody knows what medicare allows in terms of final cost for a typical blood lab report ?

Really ?

Nobody on medicare, ever, goes to a lab 1x a year for routine blood work ?

Really ?

Nobody knows the normal/average/est.cost for CBC test(s) ?

From
https://www.lifeextension.com/lab-testing/itemlc381822/chemistry-panel-complete-blood-count-cbc-blood-test  -  $35.00 and no doctor needed

...but on medicare, cost is not available via a normal Rx from primary provider and Quest|Labcorp ?

[Sibley]

Well, I'm not ON Medicare. And while my parents are, my sister handles most of the medical/insurance side. So no, I don't know how much it costs. I'm sure there's plenty of people on this board who are similar.

If you want to know how much it costs, go get the bloodwork and find out. Or ask your doctor's office billing department if they have any suggestions as to how you can find out. Regardless, work on your manners. First impressions are important, and yours isn't a good one.

[anotherAlias]

So, apparently nobody knows what medicare allows in terms of final cost for a typical blood lab report ?

Really ?

Nobody on medicare, ever, goes to a lab 1x a year for routine blood work ?

Really ?

Nobody knows the normal/average/est.cost for CBC test(s) ?

From
https://www.lifeextension.com/lab-testing/itemlc381822/chemistry-panel-complete-blood-count-cbc-blood-test  -  $35.00 and no doctor needed

...but on medicare, cost is not available via a normal Rx from primary provider and Quest|Labcorp ?

Yep, you have just hit on one of the big problems with US healthcare.  It is difficult if not impossible to find out what things cost before you are billed.  You are also posting on a forum that skews young age-wise.  I would guess that very few folks on the forums are on Medicare. 

Of the half dozen seniors that I know well enough to discuss healthcare stuff, all of them have Medigap plan F and pay for nothing other than their prescriptions.

If you have the ICD codes from an old bill, you could try calling you insurance company to see if they will tell you what they pay out and what the negotiated cost is.

Sent from my Lenovo TB-X606F using Tapatalk

[Cranky]

So, apparently nobody knows what medicare allows in terms of final cost for a typical blood lab report ?

Really ?

Nobody on medicare, ever, goes to a lab 1x a year for routine blood work ?

Really ?

Nobody knows the normal/average/est.cost for CBC test(s) ?

From
https://www.lifeextension.com/lab-testing/itemlc381822/chemistry-panel-complete-blood-count-cbc-blood-test  -  $35.00 and no doctor needed

...but on medicare, cost is not available via a normal Rx from primary provider and Quest|Labcorp ?

Check back with me in a couple of weeks. My dh just had his blood work done this week, so we’ll see what the bill is.

We switched to Medicare this summer. He has the standard Part B with supplemental policies that are subsidized by his pension. I went with an Advantage plan, which seems a lot clearer about what’s covered, but this is the first time either of us has been to the doctor.

[Dr Kidstache]

I think you could dial down the outrage a smidge.

Medicare is really quite transparent about costs. Part B doesn't have a network and is accepted by any provider (MD, lab, etc) that accepts Medicare and always for the same Medicare-allowed billing amount. If you are on original Medicare only, you have a $203 deductible for the current year and then you pay 20% of any applicable Medicare charges. Medicare posts online what is considered preventive care (the link I shared before) and any preventive care labs are covered at no cost to you. Lab work that is not preventive care but considered medically necessary is *also* usually covered at no cost to you (https://www.medicare.gov/coverage/clinical-laboratory-tests). There is a search function on those linked pages where you can search for the specific lab test even and find out if it is covered. If you would like to find out what those lab tests would cost if they somehow aren't preventative or medically necessary, you can call the Medicare-participating lab that you'd like to use and ask for the Medicare-allowed amount for those tests [and yes it's usually a lower cost than private insurance plans have negotiated] and the most you would owe is 20% of that.

I'm on Medicare because I'm eligible through SSDI. And boy am I grateful for Medicare! I have great coverage. SSDI recipients don't have access to all the same plans as people who become Medicare-eligible based on age (for example, I can't enroll in a supplemental plan and my access to Advantage plans and Part D plans is more limited). I am on a Medicare Advantage plan so the fee structure is different than if I were only receiving Parts A & B but any Medicare-participating plan is required to share information about deductibles/copays/tiers/etc in a clear statement of benefits.

[sonofsven]

I'm not on Medicare but I pay for my blood work every year (Quest) and last year it was $189.

[Cranky]

Strangely, the only thing we’ve had done since switching onto Medicare this summer is immunizations, for which we have had no out of pocket cost. But the monthly EOB says we’ve filled our deductible… so, who knows.

[Cassie]

I have Medicare and a supply so once my deductible is met I haven’t paid anything for lab work. I get it yearly because of my medical conditions.