How Medicare Helps To Reach Your Target Blood Pressure

Written by:

Jason Kolkey

8 min read

Key Takeaways

High blood pressure is a common medical issue that contributes to serious health problems for many U.S. adults.
Reaching your target blood pressure often requires a combination of lifestyle changes and prescription drugs.
Original Medicare covers services to diagnose high blood pressure and support you to make healthier choices.
To get coverage for most prescription medications, people on Medicare need to enroll in a Medicare Part D prescription drug plan or switch to a Medicare Advantage plan with prescription coverage.

According to the Centers for Disease Control and Prevention (CDC), nearly half of U.S. adults have high blood pressure, contributing to the deaths of more than 600,000 people per year. You’re at greater risk for this condition, also called hypertension, as you grow older.

Your insurance coverage plays a key role in accessing care and resources to prevent serious medical problems related to your blood pressure. If you’re like most U.S. adults 65 and over, you’re either enrolled in Original Medicare from the federal government or a Medicare Advantage plan from a private insurance carrier.

Learning about the screening and treatment services that are covered by Medicare can help you reach and maintain your target blood pressure.

Understanding Your Blood Pressure

Blood pressure is a measure of how strongly blood pushes against the walls of your arteries, the blood vessels that transport oxygen and nutrients throughout your body. When a healthcare provider checks your blood pressure by placing a cuff around your arm, they get two readings:

Systolic pressure is the force of blood flow when it’s being pushed out from your heart to the rest of your body.
Diastolic pressure is the force of the flow when your heart relaxes and fills back up with blood.

Systolic and diastolic pressure are measured in “millimeters of mercury” (mmHg), which is how much pressure it would take to raise a column of the chemical element mercury by one millimeter. Your blood pressure reading is written as the systolic pressure over the diastolic pressure, such as 120/80.

The latest guidance from the American Heart Association (AHA) and the American College of Cardiology (ACC) breaks down blood pressure readings as follows:

Normal: 90-120 mmHg systolic and 60-80 mmHg diastolic pressure.

Elevated: 120-129 mmHg systolic and less than 80 mmHg diastolic pressure.

High Blood Pressure Stage 1: 130-139 mmHg systolic OR 80-89 mmHg diastolic pressure.

- High Blood Pressure Stage 2: 140 mmHg or higher systolic OR 90 mmHg or higher diastolic pressure.
Hypertensive Crisis: Higher than 180 mmHg systolic OR higher than 120 mmHg diastolic pressure.

Keep in mind that your blood pressure might change throughout the day because of factors like exercise, drinking caffeinated beverages, or anxiety. Avoid activities that could increase your reading and check a few times to confirm that your blood pressure is consistently high.

Medicare Coverage for High Blood Pressure

Original Medicare, the federal health insurance program for people who are 65 or older or have certain disabilities, covers a variety of services that help to manage your blood pressure and address related health problems:

A “Welcome to Medicare” preventive screening within the first year after enrolling
Yearly wellness visits that include checking your blood pressure
Diagnostic lab tests
Cardiovascular behavioral therapy
Diabetes screening
Nutrition therapy
Obesity behavioral therapy
Alcohol misuse screening and counseling
Tobacco cessation counseling

Medicare may cover home blood pressure monitors under certain circumstances, but only if a doctor determines it’s medically necessary.

To get coverage for most prescription drugs taken at home, including blood pressure medications, you need a Medicare Part D plan from a private insurance carrier. Make sure you choose a plan that covers any medications you’re currently taking and find out how much you’ll pay out of pocket.

Medicare Advantage Plans and Your Blood Pressure

You have the option to switch from Original Medicare to a Medicare Advantage plan. Medicare Advantage plans (also called Medicare Part C) are offered by private insurance carriers and must at least match the coverage provided by Original Medicare. You’ll need to visit doctors and pharmacies that are in your plan’s provider network, so check whether your preferred healthcare providers are included.

Most Medicare Advantage plans include Part D coverage, and they may provide additional benefits that help control your blood pressure.

For example, if you have certain cardiovascular health conditions, you may be able to enroll in a Chronic Special Needs Plan (C-SNP), which is a type of Medicare Advantage plan built to coordinate care for people with specific health needs. C-SNPs must provide Medicare Part D coverage, and particular plans may also feature benefits like dental coverage, access to gyms and fitness classes, and a credit to pay for healthy foods.

What Medicare Advantage plans are available to you depends on your ZIP code and eligibility.

Wegovy Medicare Coverage for High Blood Pressure

Medicare Advantage and Medicare Part D prescription drug plans are able to cover the weight-loss drug Wegovy when it’s prescribed to patients at risk for heart attacks or strokes. Under federal law, these prescriptions can’t be covered if they’re used specifically for weight loss. Every plan may cover different drugs and set a range of out-of-pocket costs, so you should check what’s available from plans in your area.

Ready for a new Medicare Advantage plan?

What Causes Hypertension in Older Adults?

Your body goes through changes as you age that make it harder to maintain a normal blood pressure. For example, the arteries become stiffer, resulting in isolated systolic hypertension. This is the most common form of high blood pressure for older people, showing up as a systolic pressure over 130 mmHg, even though the diastolic pressure is still under 80 mmHG.

In addition, medical issues like diabetes, kidney disease, and metabolic syndrome — which are more likely to occur in older adults — can increase your chances of developing high blood pressure. For women, there’s also a greater risk of hypertension after going through menopause (though a higher percentage of men of all ages have high blood pressure).

High Blood Pressure Health Risks

Hypertension can lead to a variety of health problems with the potential to affect your heart, brain, kidneys, and vision:

Heart disease and heart attacks: High blood pressure harms your arteries, reducing the flow of blood and oxygen to your heart. That loss of elasticity can contribute to heart disease, chest pains, heart attacks, and heart failure. Heart disease is the leading cause of death for U.S. adults, and hypertension is one of the top risk factors.

Stroke: In a stroke, brain cells die, resulting in lasting brain damage, disability, or death. A stroke can occur when your arteries become blocked because of high blood pressure, preventing the delivery of oxygen to the brain. Atrial fibrillation (AFib), an irregular heartbeat, causes 15% of strokes and is usually associated with hypertension.

Kidney disease: High blood pressure can cause damage to blood vessels in your kidneys, which may mean the organs are unable to remove waste from your body. When you lose kidney function, you experience symptoms like nausea, vomiting, and fatigue. Untreated kidney disease may progress into end-stage renal renal disease.
Vision loss: Hypertension contributes to several conditions with the potential to damage your vision. For example, losing blood flow to your eye’s retina causes blurry vision or even blindness.

Ready for a new Medicare Advantage plan?

Achieving Your Target Blood Pressure

If you have high blood pressure, you should work with a healthcare provider to find possible causes and create a treatment plan. Reaching your target blood pressure may involve lifestyle changes, medication, or both. Here are some common strategies that your healthcare provider may recommend:

Lifestyle Changes To Lower Blood Pressure

Follow an eating plan that’s high in vegetables, fruits, and whole grains while reducing your intake of saturated fat, sodium, tropical oils, and sugar.
Limit or stop drinking alcohol.
Exercise regularly.
Get more sleep.
Use relaxation techniques to manage stress.
If you smoke, quit.

Medications To Lower Blood Pressure

When changes to your lifestyle aren’t enough, your healthcare provider may prescribe:

Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), which both work by preventing your blood vessels from narrowing.
Calcium channel blockers (CCBs), which keep calcium out of the muscle cells of your heart and blood vessels so the blood vessels relax.
Diuretics, which eliminate excess water and sodium, reducing the fluid in your blood and allowing your blood vessels to widen.

What About Low Blood Pressure?

If your blood pressure is below the normal level of 90/60 mmHg, it’s likely only a concern when paired with other symptoms such as an irregular heartbeat, nausea, dizziness, confusion, back pain, fatigue, fainting, headache, or blurred vision.

Combined with other warning signs, low blood pressure might be an effect of medication you’re taking or an indication of dehydration, Parkinson’s disease, depression, diabetes, or a nutritional deficiency. Talk with your healthcare provider to investigate these possibilities.

To hit your target blood pressure, you may need to commit to changes in your life and take medication regularly. Understanding how Medicare coverage supports your treatment plan could help you manage the health risks that come with high blood pressure.