Does Medicare Cover Blood Tests for Cholesterol?
- Medicare covers blood tests for cholesterol if you meet certain requirements. Learn about the costs of cholesterol blood test Medicare coverage.
Medicare covers a cholesterol test at least once every five years for qualified beneficiaries, and more often if you've been diagnosed with high cholesterol and need to monitor how well your medication is working to treat it.
Medicare Part D plans can also cover medications used to reduce your total cholesterol or LDL cholesterol level, though the drugs covered by Part D plans may vary.
Does Medicare Pay for Blood Tests for Cholesterol Screening?
Medicare Part B covers cardiovascular disease screening tests once every five years. Unlike many services covered by Part B, this screening is provided at no cost to you.
Cardiovascular disease screening includes blood tests for total cholesterol, high-density lipoprotein (HDL cholesterol), low-density lipoprotein (LDL cholesterol) and triglycerides. Having the recommended screening tests can help determine if you have an elevated risk of heart disease, stroke or heart attack.
- Low-density lipoprotein, known as "bad" cholesterol, contributes to arterial plaque, a sticky substance that can block blood vessels and restrict blood flow.
- High-density lipoprotein is known as "good cholesterol" because it seems to have a protective effect on your cardiovascular system. HDL carries LDL out of your bloodstream, preventing plaque from building up in your arteries.
Triglycerides are a type of fat stored in your fat cells to be used as a source of energy when needed. If your triglyceride levels get too high, you may have an increased risk of developing diabetes or heart disease.
Although free cardiovascular disease screening is only offered once every five years, you may need more frequent cholesterol testing if you've already been diagnosed with high cholesterol and take medications to keep it under control. In this case, Medicare Part B may cover the cost of more frequent cholesterol testing.
Medications to Manage High Cholesterol
Original Medicare only covers medications administered in a hospital or doctor's office. It doesn't cover medications that you purchase at a pharmacy and use at home.
To minimize your out-of-pocket medication costs, you can sign up for Medicare Part D, a type of prescription drug coverage offered by private insurance companies. Many plans cover cholesterol medications, but your out-of-pocket cost will depend on the type of plan you have.
To determine how much you can expect to pay for cholesterol-lowering medication, review your plan's formulary. A formulary is a list of prescription and generic drugs covered by a specific insurance plan.
Medicare Coverage for Preventive Care
In addition to cardiovascular disease screening, Medicare covers a wide variety of preventive services. It's important to get these services when your doctor recommends them, as early detection often leads to better outcomes.
Your eligibility for each service depends on your age and whether you have any specific risk factors. For example, if you were born between 1945 and 1965, you qualify for one hepatitis C screening. Women 40 and older qualify for one mammogram each year.
Some preventive services are available annually, regardless of your age and risk factors. For example, you qualify for one wellness visit and one flu shot each year.
Preventive screenings are also available for the following conditions:
- Lung cancer
- Hepatitis B
- Abdominal aortic aneurysm
- Alcohol misuse
- Colon cancer
- Prostate cancer