Health Insurance

Are Lab Tests Covered By Insurance?

Talor Bianchini
Talor Bianchini29 Mar 2022

Lab tests are a common medical practice that many people get multiple times a year. There are several routine lab tests recommended by professionals, like STD testing, lipid panels, and more. Most major medical insurance covers the cost of lab testing due to the Affordable Care Act. However, without a plan, lab services can get costly. 

Finding affordable lab testing can be difficult without insurance. Luckily, Mira offers comprehensive bloodwork for only $170, which covers four essential lab screenings for non-members. In addition, members get access to low-cost comprehensive STD testing. Stay up-to-date on your health by getting tested! Sign up for Mira today. 

Are Lab Tests Covered By Insurance?

Routine lab tests are an excellent form of preventative care. Lab tests can provide insight into your health, and potentially detect harmful medical conditions. There are several recommended lab tests to get each year, but the costs can quickly add up. Fortunately, most major medical insurance companies cover the cost of lab tests, including Medicare Part B. Certain lab services have limited coverage policies under Medicaid and must be deemed medically necessary in order to be covered. 

The Affordable Care Act (ACA) lists lab tests as one of the ten essential health benefits that Americans are entitled to. Therefore, almost all health plans will cover lab services that your doctor may order. Because these preventive care measures are covered in full, there won’t be a copayment or coinsurance. This stands even if you haven’t met your yearly deductible. It is important to note that these lab services may only be free to you if ordered by a doctor or other healthcare professional in your plan’s provider network. 

Under the lab services benefit of the ACA, the following tests are included:

  • Biopsies: Doctors take samples of tissue or unusual growths to test for potential health concerns.
  • Blood and fluid tests: Blood, urine, sweat, and other fluids are commonly obtained for lab testing. This can be used to look for drug interactions, nutrient levels, or the presence of certain medical conditions.
  • Pathology: Healthcare professionals use screenings such as the throat or nose swabs to determine the presence of an illness.
  • Pregnancy tests: If you get bloodwork completed to confirm pregnancy, your insurance will cover the cost.
  • X-rays and diagnostic imaging: Expensive imaging tests, such as CT scans, MRIs, and x-rays are used to identify diseases or abnormalities in the body.

Lab Tests for Adults, Women, and Children

Preventative lab services, although not covered under this section of ACA benefits, also come at no cost to you if you have insurance. There are three different categories of benefits, including adults, women, and children. 

Adults

For adults, preventative lab testing may include screenings such as:

Women

Women have unique risks to their health, especially when pregnant. Marketplace insurance plans are therefore required to offer several different preventative lab services, for both pregnant and non-pregnant women, such as:

  • HIV screening
  • Cervical cancer screening (Pap smear)
  • Gestational diabetes screening
  • And more

Children

Children are also a special group when it comes to healthcare, as they are vulnerable to many conditions. Most marketplace plans also cover preventative services for children, including lab tests like:

  • Hypothyroidism screening
  • STI screening
  • Sickle cell screening
  • And more
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Lab Tests NOT Covered by Insurance

In some instances, your lab tests may come at a cost to you. Tests considered unnecessary includes things such as genetic testing or at-home drug tests. In addition, if you decide to order tests through a laboratory without your doctor, you could face high costs unless they are deemed medically necessary by your insurance company. This must be done before you go to get your tests, otherwise, you must pay the bill yourself. 

Cost of Lab Tests Without Insurance

While they are often used for preventative measures, lab tests are also utilized to monitor chronic health conditions, like diabetes or high blood pressure. These are essential for monitoring one’s health and could require more lab tests a year than is typical. Without insurance, keeping up with routine testing may feel impossible. Luckily, many companies offer discount programs to patients without coverage to bring down their prices. Before a healthcare professional orders lab tests on your behalf, you should ask them questions about the testing to ensure it is something you need. Ask questions such as:

  • Is it an emergency?
  • What tests are you ordering?
  • Will I need to get more tests later on?
  • Does this test have any side effects or risks?
  • How much will the test cost? Is there a cheaper alternative?
  • What are you expecting to find out from this test?

The Cost Lab Tests Without Insurance

The cost of lab testing without insurance can cost upwards of $1,200. This will vary depending on where you live, where you get tested, and what kind of test you are getting. Below are some common lab tests and their average out of pocket cost

Lab Test TypeCost
Basic Metabolic Panel$330 - $1,309
Complete Blood Count$140 - $622
Lipid Panel$303 - $843
STD Testing$108 - $350
Thyroid Stimulating Hormone (TSH)$150 - $1,139
Urinalysis$129 - $643

Source: Mira

How to Save Money on Labs Without Insurance

A great way to save on lab testing is through a Mira membership. For as low as $45 a month, Mira members get access to low-cost lab testing for those who are insured or uninsured. A wide variety of lab tests are offered, including vitamin D tests, HSV screening, or lipid panels. Or, you can opt for the comprehensive health panel, which provides patients with data points on 57 aspects of their health. These lab tests are provided on the same day you order as well, providing you with quick and low-cost results. Sign up and get tested as soon as today!

Lab Testing Frequently Asked Questions (FAQs) 

If you haven’t had any routine lab testing done before, you may have some remaining questions. 

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What lab tests should I get annually?

There are several factors that may contribute to the lab tests you may need each year. This includes factors such as family history, current medical conditions, your environment, or personal habits. There are three recommended routine lab tests for adults, including:

  • Complete Blood Count
  • A1c Test
  • Lipid Panel

STD testing is also recommended for those that are sexually active. 

How long do lab results take?

Test results will vary depending on the kind of test you are getting and the laboratory that your doctor uses. For many routine lab tests, you will receive results as soon as 24 hours after your screening. Others may take up to weeks to get results back. If you don’t hear back from your doctor within a month, you should call to make sure you didn’t miss anything. 

Can your blood work change in six months?

Yes. If you have an underlying medical condition, your blood work may change every three to six months. Therefore, it is important to get routine testing to monitor your health and ensure nothing is wrong. 

How long do I fast before bloodwork?

Most blood tests require you to fast for at least eight to twelve hours before the test. Usually, your doctor will schedule the test early in the morning so that the majority of your fasting is done overnight. 

Bottom Line

Routine lab testing is recommended in order to monitor your health and keep an eye out for any medical conditions. The Affordable Care Act lists lab services as one of the ten essential health benefits, therefore insurance plans are required to offer them free of charge. As long as the services are performed in-network, you will not be responsible for a copayment or coinsurance even if your yearly deductible hasn’t been met. 

Lab testing can be expensive without insurance, so saving on other aspects of your health may be beneficial. With a membership at Mira, you’ll get access to low-cost primary and urgent care, up to 80 percent off over 1000 different prescription medications, and same-day lab testing, for only $45 per month. Non-members can get four essential health panels for only $170. Great health at a low cost; sign up for Mira today.