Yes, Medicare covers A1C tests at no cost to you. Part B pays for the A1C both as a diabetes screening tool and as a diagnostic test for managing existing diabetes. In most cases, you’ll pay nothing out of pocket as long as your provider accepts Medicare assignment.
Screening vs. Diabetes Management Coverage
Medicare covers the A1C test in two distinct situations, and the rules differ slightly for each.
If you don’t have diabetes and your doctor wants to check whether you’re developing it, that falls under preventive screening. Medicare Part B covers up to two blood sugar screening tests per year when your doctor determines you’re at risk. These can be A1C tests, fasting glucose tests, or other glucose tests Medicare approves. Notably, CMS updated its policy in January 2024 to add the A1C as a covered screening test. Before that date, Medicare only covered fasting glucose and glucose tolerance tests for screening purposes.
If you already have a diabetes diagnosis, the A1C is covered as a clinical diagnostic laboratory test for ongoing management. There’s no strict annual cap stated for diagnostic A1C tests the way there is for screenings, but your doctor needs to order the test based on medical necessity. Most people with diabetes get an A1C two to four times per year depending on how well their blood sugar is controlled.
What You’ll Pay
For screening A1C tests, you pay nothing. The usual Part B deductible and coinsurance don’t apply because the U.S. Preventive Services Task Force gave diabetes screening a Grade B recommendation in 2021. That grade triggers a federal rule requiring Medicare to waive cost-sharing for preventive services.
For diagnostic A1C tests ordered to manage existing diabetes, you also pay nothing. Medicare-covered clinical diagnostic laboratory tests carry no coinsurance or deductible. The one condition in both cases: your healthcare provider must accept assignment, meaning they agree to accept Medicare’s approved payment amount as full payment.
Who Qualifies for Screening
Your doctor needs to determine you’re at risk for diabetes before Medicare will cover a screening A1C. You qualify if you have any one of these risk factors:
- High blood pressure
- Abnormal cholesterol or triglyceride levels
- Obesity
- History of high blood sugar
You also qualify if two or more of these apply to you:
- Age 65 or older
- Overweight
- Family history of diabetes (parents or siblings)
- History of gestational diabetes or delivering a baby weighing more than 9 pounds
In practice, most Medicare beneficiaries meet at least one of these criteria simply by being 65 or older and carrying some extra weight or having elevated blood pressure.
Medicare Advantage Plans
If you’re enrolled in a Medicare Advantage (Part C) plan rather than Original Medicare, your A1C coverage is the same or better. Medicare Advantage plans are required by law to cover every medically necessary service that Original Medicare covers, including A1C tests for both screening and diabetes management. Some plans offer additional preventive benefits beyond what Original Medicare provides, so your coverage could be more generous depending on your specific plan.
The Medicare Diabetes Prevention Program
If a screening A1C comes back showing prediabetes, Medicare offers a structured program designed to help you avoid developing full diabetes. The Medicare Diabetes Prevention Program (MDPP) provides group counseling sessions focused on lifestyle changes like diet, exercise, and weight management.
Starting in 2026, CMS is expanding how this program can be delivered. Sessions will be available in person, through live video (distance learning), or through a new asynchronous online option where you complete sessions on your own schedule. The online option runs as a pilot through December 31, 2029. CMS also loosened the weight-tracking requirement: you can now self-report your weight from home or another location rather than being weighed at every session in person. These changes are meant to make the program easier to stick with, especially for people in rural areas or with mobility limitations.
How to Make Sure Your Test Is Covered
The process is straightforward. Your doctor orders the A1C test, and the lab bills Medicare directly. You don’t need to file a claim yourself. To avoid any surprise costs, confirm two things before the blood draw: that your provider accepts Medicare assignment, and that the lab processing your sample is a Medicare-participating lab. Most hospital labs and major commercial labs meet this requirement, but it’s worth asking if you’re using a smaller or independent facility.
If your A1C is ordered as a screening test, your doctor’s office will use a specific billing code that flags it as preventive. This is what triggers the zero cost-sharing. If the test is billed incorrectly as a diagnostic test when it should be a screening (or vice versa), you could receive an unexpected bill. If that happens, contact your doctor’s billing office and ask them to resubmit with the correct code.