Does Medicare Cover High Blood Pressure Treatment?
Original Medicare — Medicare Part A and Part B — covers blood pressure checks during your initial “Welcome to Medicare” preventive visit after enrollment and also at your yearly Medicare wellness visit. Medicare Advantage and Medicare Part D prescription drug plans can help pay for blood pressure medications.
How Does Medicare Cover High Blood Pressure?
The U.S. Centers for Medicare & Medicaid Services reported that 57 percent of Medicare patients who had doctor visits in 2017 had a diagnosis of high blood pressure — also called hypertension.
To detect and help prevent this common condition, Original Medicare covers annual blood pressure checks, doctor visits, blood pressure counseling and, in certain cases, monitoring.
- Annual blood pressure checks
- Blood pressure counseling
- Doctor visits
- Certain telehealth services, e-visits and virtual check-ins (ask your doctor if these are covered)
- Weight loss counseling
- Smoking cessation counseling
- Chronic care management (in certain cases if you have heart disease, asthma, diabetes or other chronic conditions)
Medicare Part A hospital insurance will cover most of the costs if you are hospitalized for high blood pressure. You are responsible for the deductible and a daily coinsurance payment for every day you are hospitalized beyond 60 days.
Medicare Part B will cover the full cost of your annual blood pressure checks, but if you require additional services or tests, you may need to meet your deductible and pay a coinsurance fee — usually 20 percent of the full cost of the visit or other service.
Medicare Advantage plans are required by law to cover everything Medicare Part A and Part B cover. However, your plan may offer additional benefits beyond what Original Medicare offers. Check with your plan’s administrator to determine your coverage for high blood pressure.
How Is High Blood Pressure Treated?
High blood pressure can often be controlled through lifestyle changes and medication. The condition typically has no symptoms, so it is important to check your blood pressure frequently.
Left untreated, high blood pressure can increase your risk of serious conditions such as heart disease, stroke and kidney failure. Uncontrolled hypertension results in an estimated 1,300 deaths every day, according to the U.S. Centers for Disease Control and Prevention.
- A family history of high blood pressure
- Being overweight
- Eating salty foods
- Excessive drinking
- Lack of exercise
In some cases, lifestyle changes alone can allow you to manage your high blood pressure. Medicare Part B medical insurance will pay for counseling services that help you change certain behaviors that contribute to high blood pressure.
If you can’t manage your blood pressure through lifestyle and behavioral changes alone, there are several prescription medications that can treat most cases of hypertension.
Does Medicare Cover High Blood Pressure Drugs?
High blood pressure can be treated with medication in most cases, but medications for hypertension are not covered by Original Medicare.
Medicare Advantage and Medicare Part D prescription drug plans — each sold by private insurers — can help with the costs of blood pressure medicines.
You may need to meet an annual deductible and have a copayment or coinsurance cost that you pay out of pocket.
Medicare Advantage and Medicare Part D plans vary depending on where you live and the type of plan you buy. Each will have a different formulary — a list of prescription drugs that the plan covers. Check your plan to get an idea about your share of the costs and see what drugs are covered for your treatment.
Medicare Coverage for Ambulatory Blood Pressure Monitoring
Medicare will cover the cost of ambulatory blood pressure monitoring (ABPM) if your doctor believes you have white coat hypertension, or blood pressure that only becomes elevated when you visit the doctor’s office or a hospital but otherwise stays within a healthy range.
If your doctor orders ABPM, Medicare will cover 80 percent of the Medicare-approved cost for the monitoring, as long as the device comes from a Medicare-certified supplier and your doctor accepts Medicare.
- Your blood pressure is higher than 140/90 on at least three separate office visits
- Two measurements are taken at each of these office visits
- Your blood pressure is less than 140/90 on at least two occasions outside the doctor’s office
- You have no evidence of end-organ damage
To measure your blood pressure outside the office, clinic or hospital setting, your doctor can order an ambulatory blood pressure monitor for you to take home.
The device has a cuff that fits on your arm with a recorder. You’ll be required to wear it for 24 to 48 hours. During this time, the device measures your blood pressure while you are awake and asleep as you go through your normal daily routine.
The ABPM readings will allow your doctor to determine if you have high blood pressure or merely white coat hypertension.
4 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2020, June). Hypertension Disparities in Medicare Fee-for-Service Beneficiaries. Retrieved from https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/OMH_Dwnld-DataSnapshot-Hypertension.pdf
- U.S. Centers for Medicare & Medicaid Services. (2020, May 21). Concerned About Your Blood Pressure? Medicare Can Help. Retrieved from https://www.medicare.gov/blog/blood-pressure-education-month-2020
- U.S. Centers for Medicare & Medicaid Services. (2019, May 1). Feel the Pressure — Blood Pressure, That Is. Retrieved from https://www.medicare.gov/blog/feel-the-pressure-blood-pressure-that-is
- U.S. Centers for Medicare & Medicaid Services. (2001, October 17). Decision Memo for Ambulatory Blood Pressure Monitoring (CAG-00067N). Retrieved from https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=5&bc=AiAAAAAAAgEAAA%3D%3D