Does Medicare Cover Cholesterol Testing?

Medicare covers one cholesterol blood test every five years. A blood test is the only way to tell if you have unhealthy cholesterol levels, as the condition has no symptoms. High cholesterol levels can increase your risk of heart attack, stroke and other cardiovascular disease.

Terry Turner, writer and researcher for RetireGuide
  • Written by
    Terry Turner

    Terry Turner

    Senior Financial Writer and Financial Wellness Facilitator

    Terry Turner has more than 30 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).

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  • Edited By
    Matt Mauney
    Matt Mauney, Senior Editor for RetireGuide

    Matt Mauney

    Financial Editor

    Matt Mauney is an award-winning journalist, editor, writer and content strategist with more than 15 years of professional experience working for nationally recognized newspapers and digital brands. He has contributed content for ChicagoTribune.com, LATimes.com, The Hill and the American Cancer Society, and he was part of the Orlando Sentinel digital staff that was named a Pulitzer Prize finalist in 2017.

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  • Published: April 13, 2021
  • Updated: September 20, 2022
  • 4 min read time
  • This page features 6 Cited Research Articles
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APA Turner, T. (2022, September 20). Does Medicare Cover Cholesterol Testing? RetireGuide.com. Retrieved September 25, 2022, from https://www.retireguide.com/medicare/services/preventive/cholesterol-test/

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Chicago Turner, Terry. "Does Medicare Cover Cholesterol Testing?" RetireGuide.com. Last modified September 20, 2022. https://www.retireguide.com/medicare/services/preventive/cholesterol-test/.

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Medicare Coverage of Cholesterol Tests

Medicare Part B medical insurance will pay for a cholesterol test once every five years as part of your Medicare coverage of cardiovascular disease screenings.

Who Needs a Cholesterol Test?
Healthy adults should have a cholesterol test every 4 to 6 years. But if you have a chronic condition such as heart disease or diabetes or you have a family history of high cholesterol, you should be tested more often.

The office visit may require a copayment, but you will pay nothing for the test itself, as long as your doctor or the qualified health care provider conducting the test accepts the Medicare-approved cost.

However, if the test exposes another medical condition that needs further attention, Medicare will no longer consider it a fully covered preventive health test. It will then be considered a diagnostic test, which means you will be responsible for the Medicare Part B deductible plus 20 percent of the cost of the test.

What’s Covered if You Have a Medigap, Medicare Advantage or Medicare Part D Plan?

If you have a Medigap policy, the plan may cover your Original Medicare out-of-pocket costs for the office visit or diagnostic tests.

Medicare Advantage plans are private plans that are required to cover everything covered by Original Medicare — Medicare Part A and Part B — so a preventive test will be covered.

Your out-of-pocket costs for a diagnostic test may vary depending on your plan. Check with your Medicare Advantage plan administrator to estimate your costs.

It’s important to note that Original Medicare does not cover the cost of cholesterol medications, but Medicare Part D prescription drug plans and most Medicare Advantage plans do cover prescription drugs.

You will need to check your plan’s formulary — a list of prescription drugs the plan covers — to see if your prescribed medications are included.

What’s Involved in a Cholesterol Test

A cholesterol test — also known as a full lipid profile — requires a health care professional to draw a blood sample.

You should check with your doctor or the lab performing the test to see if you need to fast prior to the test. Some screenings may require that you have no food or water for eight to 12 hours before the test.

Your blood sample will be tested for levels of four different substances.

Levels Measured in a Cholesterol Test
HDL (high-density lipoprotein) cholesterol
Often called “good” cholesterol, HDL cholesterol at high levels can lower your risk of heart disease or stroke.
LDL (low-density lipoprotein) cholesterol
Often called “bad” cholesterol, LDL cholesterol at high levels can cause plaque to build up in your arteries. This can cause heart disease, a heart attack or a stroke.
Triglycerides
Triglycerides are a type of fat in your blood that supplies energy. If you have high levels of triglycerides coupled with either high LDL or low HDL levels, you may have an increased risk of heart attack or stroke.
Total cholesterol
Total cholesterol is a measure of the overall levels of cholesterol in your body. It is based on your LDL, HDL and triglyceride levels.

What Your Cholesterol Numbers Mean

Understanding Your Cholesterol Numbers

Your levels for all four substances are measured in milligrams per deciliter (mg/dL).

Ideally, you want each level to be within a certain range. If your levels are outside that range, you could be at a higher risk for heart disease, heart attack or stroke.

Ideal Cholesterol Levels
SUBSTANCEIDEAL LEVELS
Good cholesterol (HDL)Equal to or greater than 60 mg/dL
Bad cholesterol (LDL)Less than 100 mg/dL
TriglyceridesLess than 150 mg/dL
Total cholesterolLess than 200 mg/dL

The numbers alone do not determine your overall heart and cardiovascular health. Your doctor will also take into account other factors that may affect your risk for cardiovascular disease.

Other Cardiovascular Health Risk Factors
  • Family history of cardiovascular disease
  • Age
  • Personal medical history
  • Gender
  • Whether you smoke
  • Whether you drink
  • Whether you’re overweight
  • How much you exercise

By analyzing the results of your cholesterol test and considering other risk factors, your doctor can determine if lifestyle changes, cholesterol medications or a combination of both is the best route for getting your cholesterol under control.

Last Modified: September 20, 2022

6 Cited Research Articles

  1. U.S. Centers for Disease Control and Prevention. (2022, July 12). Getting Your Cholesterol Checked. Retrieved from https://www.cdc.gov/cholesterol/cholesterol_screening.htm
  2. American Heart Association. (2020, November 6). What Your Cholesterol Levels Mean. Retrieved from https://www.heart.org/en/health-topics/cholesterol/about-cholesterol/what-your-cholesterol-levels-mean
  3. U.S. Centers for Medicare & Medicaid Services. (2005, January 1). National Coverage Determination (NCD) for Lipid Testing (190.23). Retrieved from https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=102
  4. American Heart Association. (n.d.). Cholesterol. Retrieved from https://www.heart.org/en/health-topics/cholesterol
  5. U.S. Centers for Medicare & Medicaid Services. (n.d.). Cardiovascular Disease Screenings. Retrieved from https://www.medicare.gov/coverage/cardiovascular-disease-screenings
  6. U.S. National Heart, Lung, and Blood Institute. (n.d.). Blood Cholesterol. Retrieved from https://www.nhlbi.nih.gov/health/blood-cholesterol