Medicare and Blood Pressure Monitoring
According to the Centers for Disease Control and Prevention (CDC), about 610,000 people or 1 in every 4 people die of heart disease in the United States. Of these deaths, almost 370,000 are attributed to Coronary Heart Disease (CHD). Symptoms of Coronary Artery Disease includes elevated blood pressures due to plaque buildup which impedes the flow of blood in the arteries.
The American Heart Association recommends regular home monitoring for people suffering from high blood pressure. This is to ensure that treatments and medication are effective in keeping blood pressure within normal ranges and prevent fatal heart attacks.
Simple blood pressure devices commonly used in homes, are the most common type of medical equipment used by individuals who have a history, or at risk of elevated blood pressure. Home monitoring is done to help a health care provider (doctor) determine whether treatments are working and more importantly warn an individual if their blood pressure has approached or reached elevated readings.
Another type is a device that is used to measure ambulatory blood pressure. This medical device also referred to as ABPM differs from your regular home-based blood pressure monitor. It is used to measure blood pressure at regular intervals for 24 hour or 48-hour periods.
To answer the question, “Does Medicare cover blood pressure monitors?” the general answer is no. Medicare does not typically cover home-based blood pressure monitors and Ambulatory Blood Pressure Monitoring (ABPM). However, there are two exceptions.
1.Medicare coverage is available for beneficiaries who are undergoing dialysis at home and use a blood pressure monitor and stethoscope. Blood pressure monitoring is critical for people undergoing hemodialysis or peritoneal dialysis. A common side effect of hemodialysis is low blood pressure which can lead to nausea and dizziness.
2.Another exception is when a doctor recommends ambulatory blood pressure monitoring. This is in cases where a doctor suspects that a patient’s elevated blood pressure is caused by a feeling of anxiety in a medical environment. Medicare covers ABPM when the doctor has conclusively proven that at-home blood pressure monitoring results are more accurate.
Even with these clear exceptions, a beneficiary must prove beyond doubt that home blood pressure monitoring is “medically necessary.” It must be prescribed by a doctor and Medicare should agree with the doctor’s analysis. All blood monitoring equipment must also be sourced from a Medicare authorized supplier.
How Much Will Medicare Pay?
After careful determination that blood pressure monitoring is covered under Medicare, the actual amount of coverage will be determined under Medicare Part B. This covers medical services and supplies that have been deemed necessary by a doctor to treat your condition. Medicare Part B also covers out-patient care, home health and rehabilitative services. Another condition is that the blood pressure monitoring equipment must be rented from a Medicare-certified supplier.
Medicare pays 80 percent for the cost of renting the blood pressure monitoring device, while the remaining 20 percent is paid by the patient. Blood monitoring equipment must be rented from a Medical-certified supplier. Renting from a participating supplier ensures that costs are within Medicare approved amounts.
For patients with Medicare Advantage or Medicare Part C, they are equally eligible for everything that is included in Original Medicare Part A and Part B plans. Holders of Medicare Advantage plans can also enjoy coverage extras that translate to larger amounts of coverage or more covered items. Medicare Advantage plans also offers different co-payment options, depending on the type of plan and variables.
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