Does Medicare Cover High Blood Pressure Treatment?
- Does Medicare cover high blood pressure treatment? In many cases, yes. Keep reading to learn more about the coverage that may be available under your plan.
Original Medicare (Part A and Part C) and Medicare Advantage (Part C) plans may cover some of the most common treatments for high blood pressure.
If you have Medicare Part A and Part B, a Medicare Supplement (Medigap) plan could help pay for your out-of-pocket costs for high blood pressure treatment covered by Medicare.
In the United States, around 45% of adults have high blood pressure, also known as hypertension.
When Does Medicare Pay for Blood Pressure Checks?
When you enroll in Medicare, you'll become eligible for a free "Welcome to Medicare" preventive visit. The visit includes several types of screenings, including measurement of your height, weight and blood pressure.
Based on your blood pressure measurement during this visit, you and your doctor can work together to develop a treatment plan that works to control your hypertension. You may also qualify for a blood pressure check during your annual wellness visit.
The wellness visit is a great time to check your progress and work with your doctor to determine if you need additional treatment to keep your blood pressure within a safe range.
If you can't get to a doctor's office, Medicare may cover certain telehealth services, including chronic care management. Telehealth gives you a way to communicate with your doctor without having to leave the house, making it a convenient option for older adults.
Your doctor may ask you to take your blood pressure at home and keep a record of the measurements to discuss during your telehealth appointment.
Some people have a condition known as "white coat syndrome," which causes their blood pressure to increase when they see a doctor or other medical professional. If your doctor believes you have white coat syndrome, Medicare may pay for ambulatory blood pressure monitoring. You'll wear a device that takes multiple blood pressure measurements over 24 to 48 hours, which can help your doctor determine if you have hypertension or if your blood pressure is elevated during appointments due to anxiety over being in a medical setting.
Does Medicare Cover High Blood Pressure Treatment Related to Modifiable Risk Factors?
Some risk factors for high blood pressure are modifiable, which means they're within your control. Two of the most significant modifiable risk factors are tobacco use and excess weight.
- The nicotine in tobacco products causes your blood vessels to narrow, forcing your heart to pump harder to get blood to your vital organs, which can lead to high blood pressure.
- Extra weight also makes your heart work harder, making it more likely you'll develop hypertension.
Your Medicare Part B plan may pay for counseling to help you quit smoking or shed excess pounds, reducing your risk of high blood pressure as you age.
Is Blood Pressure Medicine Covered By Medicare?
If you can't reduce your blood pressure by making lifestyle changes, you may need to take daily medication to keep your hypertension under control. Several types of medications are used to reduce blood pressure, including beta-blockers, diuretics, ACE inhibitors and vasodilators. Lisinopril, enalapril, metoprolol, propranolol and furosemide are some of the most common medications within these drug categories.
Original Medicare doesn't cover most prescriptions, so you can't use your Medicare Part B benefits to pay for lisinopril or another prescription medication to control your blood pressure. A Medicare prescription drug plan, known as Medicare Part D, covers prescription medications listed in the plan's formulary. Not all plans cover the same drugs, so review your options carefully before signing up for Part D coverage.
If you have Medicare Advantage that includes Part D drug coverage, your plan may pay for blood pressure medicine. Because Medicare Advantage Plans are managed by private insurance companies instead of the federal government, coverage varies based on where you live and which insurer you select.
To find out if blood pressure medicine is covered under your plan, contact your insurance company to ask about your prescription benefits.
Does Medicare Cover High Blood Pressure Treatment Requiring Hospitalization?
Medicare Part A, known as Hospital Insurance, covers the services you receive while you're admitted to a hospital for medical care that you can't get on an outpatient basis. Medicare Part B, or Medical Insurance, covers preventive care and diagnostic services you receive as an outpatient.
If your high blood pressure causes complications, you may be able to use your Medicare Part A benefits to cover inpatient care until you're stabilized and able to return home.
Medicare Advantage Plans bundle Medicare Part A and Medicare Part B with extra services, such as prescription drug coverage or coverage for routine dental care. If you have a Medicare Advantage Plan, your insurer is required to cover the same services that Medicare Part A and Medicare Part B would cover. Therefore, you may be able to use your Medicare Advantage Plan to pay for inpatient care for hypertension.
How Much Does It Cost to Treat High Blood Pressure?
Your out-of-pocket costs will depend on several factors, such as which type of drug coverage you have and whether the treatment your doctor prescribes falls under Medicare Part A or Medicare Part B. Depending on these factors, you may have to pay a copay, coinsurance or deductible for the care you receive.
