Does Medicare Cover Cholesterol Testing?

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.

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.

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.

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.

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.

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.