Nearly half of adults in the United States suffer from high blood pressure, also known as hypertension. As defined by the Centers for Disease Control and Prevention, hypertension means a systolic pressure greater than 130 mmHg or a diastolic blood pressure greater than 80 mmHg. The term is also applicable to you if you are taking medication for high blood pressure, even if it is under control.
If you’d like to know more about how you can use Medicare benefits to cover costs for your high blood pressure, read on.
- Original Medicare and High Blood Pressure Care
- Medicare Advantage and High Blood Pressure Care
- Part D and High Blood Pressure Care
- Medicare Supplemental Coverage
- What are the Different Types of High Blood Pressure?
Original Medicare and High Blood Pressure Care
Part A (hospital care) covers inpatient hospital stays and skilled nursing facilities. If you are hospitalized due to high blood pressure, Part A will cover most of the costs. You will pay a deductible ($1,556 in 2022) as well as coinsurance ($389 per day in 2022) if you are hospitalized for more than 60 days.
Also typically covered by Part A are nursing home care, hospice care and home health care.
Part B (medical care) covers two different types of services: medically necessary (services and/or supplies needed to diagnose or treat your high blood pressure) and preventative services (healthcare that detects your risk factors for high blood pressure or treats it at an early stage).
If you suffer from high blood pressure, Part B will cover:
- An annual preventative visit and wellness exam that includes high blood pressure screening
- All related doctor’s visits
- All outpatient tests
- All procedures designed to manage and treat your high blood pressure
- Weight-loss counseling and smoking cessation sessions offered by a Medicare-approved provider
When ordered by a doctor, Medicare Part B will also cover 80% of an approved amount to rent an ambulatory blood pressure monitor. The monitor must come from an approved medical equipment supplier. An ambulatory blood pressure monitor keeps track of readings both day and night through an arm cuff and a wearable recording device.
A doctor will order an ambulatory blood pressure monitor if he or she suspects one of two conditions:
- White coat hypertension, when readings are high in clinical settings but healthy otherwise – often attributable to patient anxiety.
- Masked hypertension, when readings are normal at the doctor but high otherwise.
Note: Make sure not to confuse ambulatory blood pressure monitors with regular cuff blood pressure monitors. These are not covered by Medicare unless used by home dialysis patients.
Living with more than one chronic condition?
You may qualify for Chronic Care Management under Part B if you have another condition in addition to high blood pressure. Common conditions include diabetes, arthritis and asthma.
These services include:
- An individually designed plan of care
- Regular doctor and provider check-ins
- Around-the-clock emergency provider access
- At least 20 monthly minutes of related services
Approved Chronic Care Management providers include:
- Nurse practitioners
- Physician assistants
- Nurse specialists
Providers who can NOT bill for Chronic Care Management include:
- Limited-license doctors
Medicare Advantage and High Blood Pressure Care
Medicare Advantage, also known as Part C, offers private insurer plans that cover everything from Parts A and B. That said, they differ from Original Medicare in the fact that they typically provide more extensive benefits, including:
- Prescription drugs
- Appointment transportation
- Home delivery of meals after an inpatient stay
- Gym memberships
If your blood-pressure monitor is covered by Original Medicare, it will also be covered by Medicare Advantage. Moreover, Medicare Advantage may cover monitors not covered by Original Medicare through an over-the-counter stipend. For specific coverage details, contact a licensed Ensurem agent at the number on this page.
Medicare Advantage may also cover prescription drugs used to treat and manage your high blood pressure. Different plans may carry different formularies, so make sure that your specific medication is covered under your policy.
There are many variations of Medicare Advantage Plans designed with different goals in mind. For example, Chronic Condition Special Needs Plans (C-SNPs) are a special type of Medicare Advantage Plan targeted for people with chronic or disabling health conditions, like heart disease.
These plans offer benefits and services not found in other types of Medicare Advantage Plans. One of the most notable benefits of a C-SNP is the use of care coordinators. These care coordinators help you stay on track with your care. For example, a care coordinator can help schedule appointments, get the right prescription drugs and monitor other health-related activities.
If you opt for a Chronic Conditions Special Needs Plan, you will likely have to choose a primary care doctor and get specialist referrals, while keeping in mind any of out-of-network costs.
Part D and High Blood Pressure Care
Part D (prescription drugs) is an add-on to Original Medicare, which itself does not provide medication coverage. Part D covers the following oral pulmonary hypertension drugs:
Medicare Part B covers the following given the use of medical equipment when taken.
Remember that plans vary when it comes to their formularies, so be sure to confirm that your specific medications will be covered before making a final decision.
Medicare Supplemental Coverage
These privately offered plans, also known as Medigap, bridge Original Medicare coverage gaps to help you afford coinsurance, deductibles, copays and other costs related to high blood pressure.
However, medical underwriting for Medigap can sometimes be challenging if you have a preexisting condition such as high blood pressure. Different plans carry different levels of difficulty: for example, while some may accept you if you take two blood-pressure medications, others may allow only one.
What are the Different Types of High Blood Pressure?
There are two main types of high blood pressure:
- Primary (also known as essential) high blood pressure is most common and develops over time.
- Secondary, which is caused by another medical condition or use of a particular medicine.
Risk factors for high blood pressure include diabetes, physical inactivity, obesity, tobacco use, and genetics.
If you want to know more about Medicare coverage for your heart disease, we’re here to help! Call a licensed Ensurem agent at the number on this page.