There is Medicare coverage for thyroid testing and screenings. Coverage would fall under Part B if done in an outpatient setting. If done in an inpatient setting, then Part A would cover it.
How Much Does Medicare Pay for Thyroid Tests?
When your doctor performs your thyroid tests in outpatient settings, you’ll have 80% coverage under Part B. Therefore, you’ll be responsible for the Part B deductible as well as the 20% coinsurance. Any thyroid tests given during a stay at the hospital would fall under Part A. You’ll be responsible for the Part A deductible and any other cost-sharing.
If you have a Medicare Supplement plan, any coinsurance will be covered by the plan. Depending on what letter plan you enrolled in, you may also have coverage for any deductibles. Leaving you with zero out of pocket costs.
How Often Will Medicare Cover Thyroid Testing?
In patients that are not at risk of hyperthyroidism or hypothyroidism, a test may be conducted up to two times per year. Patients who are at risk, if your doctor finds it medically necessary to test more than twice per year, Medicare may cover it.
Thyroid Tests Covered by Medicare
Doctors or health care providers may order a variety of tests to determine the status of a patient’s condition.
Below are some thyroid tests Medicare will cover:
- Thyroid-stimulating hormone levels (TSH)
- Free thyroxine (fT-4)
- Total thyroxine (T4)
- Triiodothyronine (T3)
Indications for Coverage:
- Monitor thyroid hormone levels
- Monitor the effectiveness of thyroid medications
- Determine if it’s primary or secondary hypothyroidism
- Confirm if it’s hypothyroidism or hyperthyroidism
- Rule out if it’s hypothyroidism or hyperthyroidism
- Monitor effectiveness of any therapies
Conditions Where Medicare Considers a Thyroid Test Medically Necessary
Below is a list of some of the conditions where Medicare will consider a thyroid test medically necessary.
- metabolic disorders
- certain types of anemia
- psychosis and non-psychotic personality disorders
- unexplained depression
- ophthalmologic disorders
- various cardiac arrhythmias
- disorders of menstruation
- skin conditions
- alterations in consciousness
- symptoms of the nervous and musculoskeletal system
- skin and integumentary system
- gastrointestinal system
Types of Thyroid Diseases
The thyroid gland helps regulate the body’s metabolism, regulated by the thyroid-stimulating hormone (TSH). Different diseases and disorders may affect how the thyroid functions or the structure of the gland itself.
Hypothyroidism is the result of a lack of production of thyroid hormones. Individuals with this condition may experience several signs or symptoms; while others may not have any.
Signs of hypothyroidism are dry skin, fatigue, feeling “foggy” or having poor concentration, slow reflexes, loss of hair, digestive issues (constipation), and weight gain. Other symptoms include feeling cold, fluid retention, aching muscles, and joints, slow speech, and depression. In some cases, women have had abnormally long cycles or excessive menstrual bleeding.
Although, not as common hyperthyroidism is the opposite. This condition is an overactive gland, excessively producing thyroid hormones.
In such cases, patients may have a higher metabolism. Signs may include tremors, nervousness, increased heart rate, anxiety, and excessive sweating. Individuals may notice a heat intolerance, more bowel movements than usual, unintentional weight loss, and even difficulty concentrating.
How to Get Help with Cost-Sharing for Thyroid Testing and Screenings Under Medicare
Many beneficiaries don’t know Part B does not cover 100% of your medical costs. You’re left with deductibles and coinsurance with zero caps on your maximum out of pocket costs. You can get most, if not all, your cost-sharing covered by enrolling in a Medicare Supplement plan. Medicare also does not cover any thyroid medications given at home. That’s where a stand-alone Part D plan comes into play.
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