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.
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.
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.
- 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 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.
|Good cholesterol (HDL)||Equal to or greater than 60 mg/dL|
|Bad cholesterol (LDL)||Less than 100 mg/dL|
|Triglycerides||Less than 150 mg/dL|
|Total cholesterol||Less 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.
- Family history of cardiovascular disease
- Personal medical history
- 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.
6 Cited Research Articles
- 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
- U.S. Centers for Disease Control and Prevention. (2020, September 8). Getting Your Cholesterol Checked. Retrieved from https://www.cdc.gov/cholesterol/cholesterol_screening.htm
- 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
- American Heart Association. (n.d.). Cholesterol. Retrieved from https://www.heart.org/en/health-topics/cholesterol
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Cardiovascular Disease Screenings. Retrieved from https://www.medicare.gov/coverage/cardiovascular-disease-screenings
- U.S. National Heart, Lung, and Blood Institute. (n.d.). Blood Cholesterol. Retrieved from https://www.nhlbi.nih.gov/health/blood-cholesterol