Changes in Medicare coverage

[marielg]

My husband went to the lab for his bloodwork before his appointment with the doctor next week. He was told at the lab that Medicare won't cover it stating Medicare will cover one blood work up a year and that September is the only month. I never received notification of this change so I researched on this and found nothing relating to that. Anyone know anything about this? I live in PA

[SummerOnTheWay1]

[Monday 4/20/26]

Just thinking about you dear Marie @marielg , any updates?

Take care my friend,

Nicole  💛🤗

[GailL1]

@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) 

[marielg]

Thank you for you quick response. I would think my husband who has cardiomyopathy, diabetes, high blood pressure, high cholesterol & obesity would qualify. But what do I know. I have a feeling that it is the hospital organization that put this in place. I have tried to reach out to someone there but have had no response. 

[SummerOnTheWay1]

[Tuesday 4/7/26]

Hi @marielg , did you try to CALL Medicare & did your husband's MEDICARE Primary Care doctor "submit" an ORDER for this bloodwork?

*** Good to see you posting AGAIN & hope you can get this all sorted out. Medicare has its challenges at times. 🤞

Take care my friend,

Nicole  🤗💛

[marielg]

  Hi Nicole!! Hope all has been well with you. The answer is yes, his doctor had orders written up for him. The more I look into it the more skeptical and frustrated I become. His doctors appointment is Thursday so hopefully we can clear this up. 

Take care,

Marie

[SummerOnTheWay1]

[Tuesday 4/7/26]

Hi Marie @marielg , I had something similar happen to me. Quest had SUBMITTED the "wrong" code.

Calling Medicare is what got things RESOLVED for me.

And YES, being on "hold" is awful but lol - I was NOT paying the Quest bill!!!

Take care my friend,

Nicole  🤗💛

[SummerOnTheWay1]

[Saturday 4/11/26]

Hey Marie @marielg , any "updates"?

Take care my friend,

Nicole. 🤗💛

[marielg]

Sorry, no updates only sheer frustration.  The hospital said if the bloodwork prescription is in the computer (and it was) it would have been done. I went to sign into my Medicare account and it wanted me to send a copy of my license. I refuse to send any identifying item with my picture, birthdate and address across the internet. I have given up.😕  For now.

[GailL1]

@marielg wrote . . . . . I went to sign into my Medicare account and it wanted me to send a copy of my license. I refuse to send any identifying item with my picture, birthdate and address across the internet.

————————————-

I think you are talking about the recent security changes that SSA and Medicare have initiated - using the ID.me format.

ID.me is a secure digital identity network that allows individuals to verify their identity once and use it across multiple online platforms, including government agencies (like the IRS) and private businesses. It acts as a digital wallet to prove identity, manage data, and access services securely.

-SSA.gov - Learn about changes we’re making to your personal my Social Security account- FAQ 

from the link”

Can I still use my Social Security username to sign in?

No. Effective June 7, 2025, Login.gov and ID.me are now the only sign in options to access Social Security online services. We have removed the option to sign in using a Social Security username and password.

You will be required to create an account with ID.me or Login.gov to access our online services. If you already have a Login.gov or ID.me account, you can use your existing account to access our online services.  

Medicare.gov - Your Account Log-in Options 

from the link 

You can now create or log in to your secure Medicare account using ID.me, CLEAR®, or Login.gov. These are free, secure services that verify your identity. Verifying your identity helps us prevent fraud and make sure you're the only one who can access your information.

[more at the link]

[SummerOnTheWay1]

[Sunday 4/12/26]

Ok Marie @marielg , I just RE-read your "original" post after reading your post TODAY.

Sorry, my previous response was based on me thinking his bloodwork was COMPLETED & Medicare was "denying" paying.

➡️[*** What is MEDICARE saying IF you CALLED them?

➡️[*** Have you seen a COPY of his order?

*** Bottom line, the path between your DOCTOR - BLOODWORK PLACE - MEDICARE, something is messed up.

I do my Bloodwork EVERY Wellness Visit and as you already know we get ONE each year for free. I maybe calling the visit the WRONG title  🙄, but it is the "free" yearly visit with our MEDICARE PRIMARY CARE DOCTOR.

Take care my friend,

Nicole  💛🤗

[marielg]

words cannot describe the frustration and anger I feel.  My husband has been going to the doctor every 4 months for checkup on his major illness. He also has had blood work each time until this time. It wasn't his wellness check up as supposedly that is not included in a "wellness check  up". I am learning from various articles that what you call the appointment is important. Ridiculous as it seems.   

Today I received an email from the hospital stating to contact medicare. He gave me a number for the dept of aging for our state , so I called them. The woman told me I have have to call the dept of aging for our count and speak with the medicare counselor there. I am leaving thay for tomorrow as I am so worked up.

As the saga continues I will keep you informed. I am now considering not going to the doctors except for my free "wellness Check up."😕

[GailL1]

@marielg 

Medicare . gov can give you lots of good info about what is covered under Original Medicare. 

Like this - let’s say you just enrolled in Medicare and wanted your doc to do the “Welcome To Medicare” Preventive Visit

You go there on the Medicare site and it will tell you specifically what is covered and how it is covered.

Medicare.gov - “Welcome To Medicare” Preventive Visit 

Not exactly what you thought, is it?

Then the next year, after 12 months, you want to see if you want the Yearly “Wellness” Visit - you look that up and it tells you specifically what is covered under this type of visit to your PCP.

Medicare.gov - Yearly “Wellness” Visit  

You can look up many treatments and test - most all will begin by saying that they have to be medically necessary - You just go to this page and put in the name of the test or procedure and then SEARCH it. 

Medicare.gov - WHAT’S COVERED? 

I am assuming that you have Original Medicare and not a Medicare Advantage plan.  They cover the same things but just in a different way.  

I will be glad to help you but you will need to give more info.  Try the Dept of Aging - maybe they can help you.

[SummerOnTheWay1]

[Monday 4/13/26]

Marie @marielg , I am SO SORRY about all this!!! 😤

Yes, MEDICARE is a "challenge" and they have NO mercy with what they will pay for.

Yes, LOA (office of aging) will HELP you for free. I set up a YEARLY appt with them when it comes to the famous October to December chance to CHANGE my standalone Part D if desired.

I can imagine the STRESS you are BOTH under!!!

Yes, please keep us posted when you can. Gail @GailL1 KNOWS ALOT ABOUT MEDICARE & has been VERY HELPFUL to us all. While she does NOT work for AARP or Medicare, she does keep on top of the changes that take place.

Take care my friend,

Nicole  💛🤗

[SummerOnTheWay1]

[Thursday 4/16/26]

Marie @marielg , fingers "crossed" you have some GOOD news for us = got the "issue" RESOLVED!!! 🤞

Take care my friend,

Nicole  🤗💛