Changes in Medicare coverage

@marielg 

Any particular one(s)?

I do NOT see that there has been any recent changes -

Medicare (including MA plans) ONLY cover blood/lab work under (2) separate conditions:

1,  If they are deemed to be medically necessary for a diagnosis or treatment review.  The coding makes all the difference here.

Medicare.gov - Diagnostic Laboratory Test 

2. Certain ones which are covered as a preventive measure and within the guidelines of the particular one.

Medicare.gov - Preventive and Screening Services 

Like if you look at  Cardiovascular disease screenings - it will take you to another page and it will tell your the prerequisites - in this case the lipid study is covered every (5) years.  A beneficiary gets these with no out of pocket cost.

Now if your husband already has an issue with his C-V like his cholesterol -  then it is not preventive, it is diagnostic and the doc has to code it as such to be covered at the regular Medicare Part B rate.

Nothing has changed with this - always been this way.  A providers office or a lab may give a beneficiary a ABN (Advanced Notice of NON-coverage) to sign and check their options if they suspect that Medicare may not pay for the blood work.

Then the beneficiary decides what they want to do - by selecting Option 1, 2 or 3.

Medicare.gov-Your Protections 

Here is a sample of the form (CMS -R-131) for labs and the options.

CMS.gov - Sample of CMS-R -131 - Advance Beneficiary Notice of Non-coverage (ABN)