If you’ve ever visited a doctor for anything at least a few times in your life, chances are you’re familiar with lab tests. If not, it’s probably only a matter of time before you need one.
Lab tests are done for a wide variety of reasons, both as part of preventive care when assessing risks for certain conditions, as well as to confirm medical diagnoses. They are often the only sure way for a doctor to accurately diagnose a condition.
But are lab tests covered by insurance, or does it matter what the test is for? And is the cost of bloodwork with insurance cheaper than without? And what does this mean for people who have no health insurance? We examined these issues and discerned the facts about lab test costs, below.
Does Insurance Cover Lab Tests?
Most major health insurance providers cover the costs of lab tests, irrespective of whether they are subsidized health plans or private health insurance policies. For example, Medicare Plan B policyholders are also covered for most lab tests.
However, some insurance policies only provide coverage for certain lab tests, and only those that are deemed urgently and medically necessary. As such, your health insurance won’t cover most tests for preventive health. It will, however, cover tests to confirm a diagnosis of chronic or life-threatening conditions.
If you are on a health plan subsidized under the Affordable Care Act (also known as Obamacare), you will be covered for almost all medical lab tests. When deemed medically necessary and recommended by a doctor, they are seen as essential benefits. You won’t usually have to make a co-payment.
The Types Of Lab Tests Covered By Insurance
Health insurance will cover a wide selection of tests such as:
- Blood and urine tests
- Throat or nose swabs
- Tissue samples and biopsies
- Pregnancy tests that involve blood work
- Pap smears
- STD tests
- Certain preventative tests such as for cholesterol, high blood pressure, and hepatitis B & C
Your plan should also cover diagnostic imaging such as X-rays, CT scans, and MRIs. However, these procedures may entail additional costs depending on where you have them done and the type of coverage you have. Always check with your health insurance provider if you are unsure.
Which Lab Tests Are Not Covered By Health Insurance?
Not all lab tests are deemed medically necessary, and this is where having health insurance will not help you. Genetic tests for allergies, at-home DNA tests for establishing your heritage, and even at-home drug tests are all lab tests in their way. However, your health insurance plan will not cover these costs.
Even lab tests that seem to be for medical reasons at first glance may not be covered on certain plans. These are usually tests that fall under preventive health. While they are of great value in your day-to-day health, they lack the urgency of other tests.
There are a variety of at-home tests that you can purchase at a more affordable price at drugstores. These include at-home Covid tests, drug tests, and pregnancy tests. You won’t need a prescription to buy them, and it won’t matter whether or not you have health insurance.
Note that the results are highly dependent on the conditions of your testing environment. Home tests are not 100% accurate, and are meant to be used as a guide, only. If a home test gives a positive result, go to a doctor for confirmation of the result.
How Much Do Lab Tests Cost Without Insurance Coverage?
Without health insurance coverage, lab tests can be very expensive. If the tests are not immediately urgent but are still medically necessary, you may prefer to delay them until you’re covered by an affordable health plan.
If the tests you’re thinking of having done have no immediate medical benefits, you may want to put them off altogether. Otherwise, expect to pay high fees out-of-pocket.
Of course, you will want to go ahead and have medically necessary lab tests. Tests for conditions that will impact your life in a major way, such as STD testing, are probably not a good idea to postpone, either. STDs are usually highly transmittable, and you need to know your status as soon as possible to protect any partners you have.
Average Lab Test Out-Of-Pocket Costs
We looked at the possible out-of-pocket costs for three common lab tests that your doctor may recommend. As these can diagnose chronic and even potentially life-threatening illnesses, it is advisable to have them done at the earliest convenience.
A metabolic panel measures different substances in your blood related to your body’s metabolism and chemical balances. It can be used to diagnose or confirm diabetes, high blood pressure, kidney disease, or liver disease. You can expect to pay up to $1,300.
A lipid panel test is a means of measuring specific fat molecules (called lipids) in the bloodstream. The risk of high cholesterol and cardiovascular disease, and even a stroke, or a heart attack, can be predicted from a lipid test. You can expect to pay up to $800 for a lipid panel test.
Urinalysis tests are very common tests done on urine specimens. A whole host of medical issues from minor urinary tract infections to more serious conditions like kidney disease and diabetes can be detected this way. For urinalysis tests, you’ll have to pay up to $650.
What About Health Insurance Alternatives?
Many Americans who don’t have health insurance rely on alternative systems to cope with healthcare expenses. Do these alternatives offer assistance with lab tests?
Medical cost-sharing programs like Medi-Share or health service subscription programs are not health insurance. The cost-sharing system helps to pay for medical bills out of the pooled contributions of members.
Medi-Share does not generally cover the cost of X-Rays or other imaging, nor does it cover lab tests. But, they do offer a limited amount of ante-natal care. Medi-Share will assist with most other medical bills for unexpected medical events.
Subscription services known as care memberships also don’t cover lab tests. Instead, for a monthly fee, they offer access to a limited number of medical services like general checkups and cold or flu treatments.
Some may include more advanced medical care, but lab tests are usually not included. Care memberships are only useful for people who have no serious medical conditions and hardly ever go to the doctor.
There’s No Alternative To A Good Health Insurance Plan
Your best bet if you don’t have health insurance is to contact us at Enhance Health, We have helped countless people just like you find affordable health insurance that meets their health and lifestyle needs.
Even if you are unemployed or earn a minimum wage, we can find a plan that works for you.
Frequently Asked Questions About Lab Tests
Are there alternatives to lab tests?
Some illnesses are hard to diagnose without a lab test or imaging test of some other kind. This is because lab tests look for markers in the blood (or sometimes urine or other fluids) that can’t be detected with just a physical examination.
Are some lab tests free even without insurance?
Certain community clinics or reproductive health centers offer free pregnancy tests and STD screening. If you test positive for an STD, you may receive STD treatments for free as well, or at a low cost. However, this is not available at every location and you’d have to enquire about this first.
Why are lab tests expensive?
The costs often depend on the type of test, but in general, the high costs can be attributed to the need for specialized equipment. For example, PCR tests are fast and accurate, but require highly sensitive equipment and infrastructure. This drives up the cost.
Lab tests are used by doctors and hospitals worldwide to diagnose and monitor medical conditions, some of them very seriously. They are usually of great benefit as a predictive tool, too, highlighting a patient’s chances of developing a particular medical condition.
However, the cost of lab tests without insurance is, in some cases, prohibitive. That is why it is in your best interests to enroll in a health plan as soon as possible. Medically necessary lab tests are covered by most health insurance plans.
Don’t risk your health – let us help you choose a plan that you can afford.