Does insurance cover lab tests?

Whether it’s checking your cholesterol, screening for diabetes or monitoring a chronic condition, lab work is a routine part of health care. These tests analyze samples of blood, urine or tissue to help doctors diagnose conditions, track treatment progress or detect issues before symptoms appear. But not all lab tests are covered the same by health insurance plans. Here’s what you need to know about lab work to avoid unexpected out-of-pocket costs.

Are lab tests covered by insurance? Let’s break it down.

Lab tests are generally covered by insurance as long as they’re medically necessary or part of recommended preventive care. That means the test must be recommended by your doctor to diagnose, treat or prevent a medical issue.

Types of lab tests typically covered by insurance

Most preventive or routine diagnostic lab tests are covered partly or entirely by insurance. Common lab work includes:

• Biopsy procedures – A small sample of tissue or cells is removed and examined under a microscope to diagnose a variety of conditions including skin cancer, infections and autoimmune diseases.
• Certain sexually transmitted disease (STD) tests – Most health plans cover certain STD tests like HIV, chlamydia, gonorrhea, syphilis and Hepatitis B. Some of these are covered under preventive care benefits.
• Cholesterol screenings – These measure the level of cholesterol in your blood. People with high cholesterol are at greater risk for cardiovascular diseases like heart disease and stroke.
• Colorectal cancer screenings (for adults ages 45 to 75) – Depending on your risk factors and doctor’s recommendations, screening can be done through stool tests that check for hidden blood or abnormal DNA, or a colonoscopy to examine the colon for precancerous growths or polyps.
• Hepatitis screenings (for high-risk patients) – These screenings include a group of blood tests to check if you have a Hepatitis A, B or C infection, or have had one in the past.
• Prenatal testing – These include screenings performed during pregnancy to monitor the health and well-being of both mom and baby.
• Routine blood count and metabolic panels – These procedures help establish a baseline for your overall health and catch potential issues early. They can also be used to monitor chronic conditions or treatment effectiveness.
• Throat and nose swabs – These are used to test for viruses and bacteria that cause respiratory infections (like strep throat and COVID-19).
• Tuberculosis screenings (for high-risk patients) – Your clinician can use a blood or skin test to determine if you’ve been infected. Results take between 48 and 72 hours.
• Type 2 diabetes screenings (for adults ages 40 to 70) – Diabetes screenings include a variety of blood tests to help detect signs of prediabetes or Type 2 diabetes early when they’re easier to manage.

Some at-home lab tests can be covered by insurance

At-home testing kits for things like COVID-19, blood glucose, HIV or colorectal cancer screenings may be covered by your health plan. But check with your insurer before purchasing.

Lab tests can be covered under multiple areas of coverage

The two most common areas of coverage that lab tests fall under are lab services coverage and preventive services coverage.

• Lab services coverage – Your health plan covers the medically necessary tests your doctor orders to diagnose or treat disease or illness. Common examples of this are cholesterol, blood sugar and blood panels that might be used to diagnose high blood pressure, hypertension or diabetes.
• Preventive services coverage – Your health insurance covers lab tests listed on the United States Preventive Services Task Force (USPSTF) A&B recommendations. Examples of this include pap smears for cervical cancer, HPV or STD screenings or the testing required to determine the results of Fecal Immunochemical Test (FIT) kit for colorectal cancer screening.

Common reasons lab tests aren’t covered by insurance

Not all lab tests are covered by insurance. For example, tests done for curiosity, health optimization and improvement, or without a doctor’s recommendation are generally not covered. Some examples include:

• Cortisol stress tests
• Food sensitivity or intolerance panels
• Gastrointestinal health panels
• Genetic testing (varies by family history and risk)
• Hormone testing
• Heavy metal panels
• Tests that aren’t FDA approved or aren’t approved for the reason you’re seeking it

Your health insurance provider may also deny coverage if:

• You received care out of network
• The test is not medically necessary
• The test is experimental or investigational
• Prior authorization wasn’t obtained

If your claim is denied, your insurance company must tell you why. You also have the right to file a complaint or to appeal the outcome of a coverage decision.

How to find out which lab tests your insurance covers

If you’re a HealthPartners member, there are three easy ways to check your coverage so you’ll know what to expect and avoid unexpected costs:

1. Check online – Sign in to your HealthPartners online account to see which services and tests are covered by your HealthPartners plan, check your balances, review your claims, and more.
2. Send us a message – Email Member Services about your coverage and benefits, claims, or other insurance questions.
3. Give us a call – Call the number on the back of your member ID card to talk to Member Services about your coverage.

How much does lab work cost with insurance?

How much you pay out of pocket for lab tests depends on:

• If your provider is in network or out of network
• The type of health plan you have (for example, what you pay with a high-deductible plan could be different than what you’d pay with a copay plan)
• What lab tests your plan covers
• Whether your test is considered medically necessary, preventive or experimental

Even if your lab test is covered, you may still have out-of-pocket costs. Before your health insurance coverage kicks in, most members will pay into their deductible (what you pay for all covered care before your plan starts to help pay). Once your deductible is met, you’ll have a copay (flat fee you pay for covered care) or coinsurance (your share of the cost for covered care after you’ve paid your deductible) that’s set by your insurance company. All these factors can contribute to what you end up spending out of pocket.

How much do lab tests cost without insurance?

Without insurance, the cost of lab tests can vary widely depending on the test and where it’s done.

Ways to save on lab work

• Use in-network providers – Many health plans contract with specific providers so their members can receive health services at a more affordable rate when they get care in network vs. out of network.
• Compare prices at local labs – Standalone test centers often have lower costs and simpler billing for routine lab work.
• Look for free or low-cost clinics in your area – Some non-profit or student-run clinics offer lab work free of charge or at a lower cost for underrepresented and underinsured patients.
• Use your HSA or FSA to pay for lab work – If your health plan includes a health savings account (HSA) or a flexible spending account (FSA), you can use the funds to pay for a variety of lab tests and screenings.