Medicare Users Face Lab Test Changes Feb. 1—But Congress Is Fighting to Protect Your Coverage
Medicare’s new rules could limit access to routine lab tests—see if you’re affected and what’s next.
At the end of January, Medicare users are going to face a major shakeup. Starting February 1, Americans on the government-funded health insurance program are expected to feel the effects of reduced reimbursement rates for many of their routine diagnostic tests. Below, we share everything you need to know about this important healthcare update, including how Congress is working toward stopping it.
A look at the Medicare changes happening this month
In 2014, the Protecting Access to Medicare Act (PAMA) was signed into law, giving Medicare beneficiaries access to the highest quality diagnostic testing and clinical lab results and making prices comparable to what other insurers pay.
The bill was met with considerable pushback, leading to flawed implementation, several laboratory budget cuts and restricted access to test results. Over the years, lawmakers have tried to figure out ways around this, but nothing has worked. Government employees have also tried to find a better way for labs to report their testing data to the Centers for Medicare & Medicaid Services, but over time the data collected failed to accurately show how much these procedures cost, resulting in massive shift in February of 2026.
Right now, there’s a 0 percent reduction cap in place for Medicare Part B users, which means patients don’t have any upfront costs for these lab tests. But in a few weeks, the government plans to reduce that coverage for over 800 tests, cutting reimbursement rates by 15 percent. This change is a result of faulty data collection and is expected to limit seniors’ medical test options, as the cuts could force labs to close or reduce staff. This shift will also likely make it harder for Americans to find a place to get medical tests done and could mean longer wait times for results.
Congress is working to fight this change and recently introduced the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services Act, which would make the reduction cap 5 percent instead of 15. It could also make it easier for labs to collect data, which in turn will make it easier for seniors to get the care they need.
“Without any action from Congress, beneficiaries could soon see a reduction of up to 15 percent on over 800 tests that currently fall into the schedule,” Alex Beene, a financial literacy instructor for the University of Tennessee at Martin, told Newsweek. “The bill, which is gaining bipartisan support, would look to halt some of these complications and cap Medicare reduction at 5 percent, while also adjusting some of the data reporting requirements that were viewed as not always fully capturing different segments of the clinical lab market in the past.”
What we know so far about the new Congress bill
The Reforming and Enhancing Sustainable Updates to Laboratory Testing Services Act is still being discussed by Congress and there is no update on when they could vote on it. Even so, Georgia Senator Reverend Warnock, one of the bill’s main supporters, remains hopeful.
“Access to quality clinical labs is essential to keeping our seniors living long, healthy lives,” the senator said in a statement “I’m proud to partner with my colleague Senator [Thom] Tillis [from North Carolina] to put forward this legislative fix that will help ensure Georgia seniors will continue to have access to high-quality diagnostic services.”
Tills echoed a similar sentiment, saying in that same statement, “It is critically important that seniors have uninterrupted access to innovative diagnostic tests.”
“The Reforming and Enhancing Sustainable Updates to Laboratory Testing Services Act is a necessary step toward ensuring this access and supporting seniors’ healthcare needs,” he continued. “I’m proud to work with my colleagues to permanently fix flawed data collection and reporting methods, which will allow Medicare beneficiaries to continue receiving quality and affordable lab services.”
Once the Senate votes on the act, it will go to the House of Representatives. If they pass it, it will then go to President Donald Trump’s desk, where he will either vote it into law or reject it altogether. As of publication, there is no news on how any of them are leaning.
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