Does Medicare Cover Blood Pressure Monitors?
Key Takeaways
- Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). typically doesn’t cover a blood pressure monitor but may if a doctor considers it medically necessary or if you’re receiving in-home renal dialysis.
- Some Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plans help pay for blood pressure monitors through an over-the-counter credit.
- Medicaid may help pay for blood pressure monitors. Coverage varies based on your state of residence.
Original Medicare (Parts A and B), the public health insurance program for people who are 65 and older or have certain disabilities, typically doesn’t cover blood pressure monitors. However, Part B, which is medical insurance, may provide coverage for monitoring under certain conditions if your healthcare provider determines it’s medically necessary.
Some Medicare Advantage plans from private insurance carriers offer additional benefits and may provide credit for over-the-counter items, including blood pressure monitors.
Let’s take a closer look at why home blood pressure monitoring matters and how you may be able to get help with the costs of a blood pressure cuff.
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Stay Ahead of Hypertension
Uncontrolled or chronic high blood pressure can lead to serious conditions like heart attack, stroke, and kidney damage. Healthcare providers measure your blood pressure with two readings: the systolic pressure or the force of blood being pushed out from your heart, over the diastolic pressure, the force of blood flow when your heart fills up again.
- According to current guidance, blood pressure readings of 90-120/60-80 are in the normal range.
- Among adults who struggle with uncontrolled blood pressure, 45% have readings of 140/90 or higher, which is considered Stage 2 hypertension.
Regular monitoring helps to anticipate and prevent complications from high blood pressure. In between doctor’s office visits, you can likely get your blood pressure checked at your local pharmacy.
If you need to (or prefer to) test your blood pressure at home, equipment like a self-measured blood pressure monitoring (SMBP) device or an ambulatory blood pressure monitoring (ABPM) device could be key to staying on top of your health.
The American Heart Association recommends an automatic, cuff-style monitor that goes over your upper arm. Make sure the device fits your arm, and have your healthcare provider verify that you’re using it properly.
Does Medicare Cover Blood Pressure Cuffs?
High blood pressure is treatable, but only when it’s diagnosed. Monitoring your blood pressure may allow you to spot hypertension early and stay in control after diagnosis.
Medicare Part B does not typically cover blood pressure monitors, as it only pays for medically necessary durable medical equipment. However, Medicare may cover an ambulatory blood pressure monitoring device that is worn for 24-48 hours to diagnose hypertension if you have a condition that interferes with diagnosis, such as:
- White coat hypertension, when your blood pressure goes up because of stress or anxiety while you’re in the doctor’s office.
- Masked hypertension, when you have a normal blood pressure at the doctor’s office, but it goes up at other times of day or in other locations.
Part B also typically covers a blood pressure monitor if you are receiving in-home dialysis to manage kidney disease or failure.
Coverage For Blood Pressure Monitors With Medicare Advantage
While Original Medicare doesn’t cover blood pressure cuffs in most cases, some Medicare Advantage plans may.
Medicare Advantage Plans are offered by private insurance companies and required by law to cover, at minimum, all the services that Original Medicare does. These plans differ based on the insurance carrier and your location. Most include Medicare Part D prescription drug coverage, and certain plans available in your area may offer additional benefits like hearing, vision, dental, fitness, and telehealth
Some Medicare Advantage plans include an over-the-counter allowance, which can be used for a wide range of items from toothpaste to blood pressure monitors. The funds often come loaded on a prepaid debit card to be used at approved locations or by ordering items from a catalog online or over the phone.
If you have certain cardiovascular disorders or another chronic condition, you may qualify for a Chronic Condition Special Needs Plan (C-SNP). These are Medicare Advantage plans designed for people with specific healthcare needs and may provide a variety of targeted benefits.
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How Much a Blood Pressure Monitor Costs With Medicare
If you need a blood pressure monitor and Original Medicare doesn’t cover it, you will pay 100% of the cost. If covered by Part B, a Medicare blood pressure monitor will be covered the same way as other durable medical equipment. That means Part B covers 80% of the Medicare-approved amount for the purchase of a blood pressure monitor or the rental of an ABPM device after you have paid your annual deductible.
Medicare Advantage plans provide at least the same level of coverage that you would get from Original Medicare. Some Medicare Advantage plans may help with costs beyond what Part B covers, reducing how much you pay out of pocket.
Other Options For Getting Blood Pressure Monitor Coverage
Because Original Medicare Parts A and B don’t cover blood pressure monitors unless they’re deemed medically necessary, you may explore other ways to access a monitor. Here are a couple of options to consider:
- Local Pharmacy: Most pharmacies have blood pressure machines that are available for public use.
- Medicaid: Medicaid, the public health insurance program for people with limited incomes and resources, may help pay for blood pressure monitors. Every state administers its own Medicaid program, so you should find out what’s covered where you live.
Putting It All Together
Checking your blood pressure regularly is important to find cardiovascular problems early and effectively manage high blood pressure. Original Medicare doesn’t often cover at-home blood pressure monitors, but there are other options to consider, like enrolling in a Medicare Advantage plan or Medicaid, or using the monitor at your local pharmacy. Take charge of your health and choose the option that works best for your lifestyle.
Sources
Home Blood Pressure Monitoring. American Heart Association.
High Blood Pressure Facts. CDC.
Durable Medical Equipment. Medicare.gov.