Yes, Medicare will cover blood pressure monitors if you meet certain requirements and your doctor deems it medically necessary.
Original Medicare is comprised of two parts, each of which may offer coverage for blood pressure monitors.
- Part A: Covers inpatient services. This part of Medicare will cover blood pressure monitoring services while the patient is in the hospital.
- Part B: Covers doctor visits and other outpatient services. This part of Medicare will cover an at-home monitor purchase or rental, depending on your situation.
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Why Blood Pressure Monitoring Matters
Blood pressure is the pressure of your blood pushing against your artery walls. A blood pressure reading looks at two measurements:
- Systolic blood pressure: The first number measures the pressure in your arteries when your heart beats
- Diastolic blood pressure: The second number measures the pressure in your arteries when your heart rests between beats.
A normal blood pressure reading is 120/80. High blood pressure, also known as hypertension, can lead to health complications such as heart attack or stroke. You may need to monitor your blood pressure at home to ensure you are regularly in a healthy range.
Understanding Medicare Coverage for Blood Pressure Monitors
If you or someone you care for are Medicare beneficiaries and have hypertension, it is important to understand the eligibility requirements and which parts of Medicare may offer coverage.
Eligibility
To be eligible to receive a blood pressure monitor for in-home use, you will have to meet certain eligibility requirements.
Medicare will cover a blood pressure monitor or an ambulatory blood pressure monitor (ABPM) for in-home use if you have hypertension and your doctor requires you to monitor your blood pressure throughout the day.
If you’re suffering from kidney failure and are receiving dialysis treatments at home, Medicare will also cover a blood pressure cuff and stethoscope to monitor your blood pressure during treatments.
Medicare Part A Coverage
Medicare Part A is referred to as hospital insurance and covers inpatient services. If you are admitted to a hospital or another inpatient facility, Part A will cover the cost of monitoring your blood pressure during your stay.
Medicare Part A has a $1,600 deductible per benefit period. A benefit period can refer to a hospital stay, and it’s possible to have more than one benefit period per year. For example, if you were admitted to the hospital on three separate occasions, that would be three separate benefits periods and three separate deductibles.
Medicare Part B Coverage
Medicare Part B is referred to medical insurance and covers outpatient services such as doctor visits, home health services, and medical devices. Medicare Part B will provide coverage if you’re eligible for a blood pressure monitor for at-home care.
Part B will cover one blood pressure monitor or rental costs of an ABPM once per year. You would be responsible for any outstanding deductible and the 20% copay. The Medicare Part B annual deductible in 2023 is $226.
Medigap Coverage
A Medigap policy, also known as a Medicare Supplement policy, is an optional policy sold by private insurance companies to help cover any deductibles and copays associated with regular Medicare. Depending on your Medigap plan, a blood pressure monitor may or may not be covered.
For example, Medigap Plan A does not cover Part B excess charges, whereas Medigap Plan G does. If you have a Medigap plan, contact your provider to confirm if your plan will cover a blood pressure monitor.
How Does Medicare Advantage Cover Blood Pressure Monitors?
A Medicare Advantage Plan is a health insurance plan you can elect instead of Original Medicare. These plans cover the same services as Medicare Part A and B but combine both parts into one plan. They also often offer additional services such as prescription drugs, vision care, and dental services.
If you meet the Medicare criteria for needing a blood pressure monitor, your Medicare Advantage Plan will cover your monitor. However, this may be subject to a high deductible as some MA plans may have a much higher deductible than Original Medicare. Also, MA plans may require you to visit an in-network provider.
If you have a Medicare Advantage Plan, contact your plan provider to confirm what is covered regarding a blood pressure monitor.
How Much Do Blood Pressure Monitors Cost With Medicare?
The cost to rent an ABPM from a physician’s office can range from $200-250 per rental. Medicare will cover one rental per year if you meet the eligibility criteria and is subject to your Part B deductible and copay.
For a regular blood pressure monitor, the costs can range from $30 to over $100. If you are eligible, Medicare Part B will cover one device per year. You would be responsible for any outstanding portion of your Part B deductible and the 20% copay. If you have a Medigap policy that covers blood pressure monitors, that plan may pick up the 20% copay.
Medicare Advantage Costs
The costs of a blood pressure monitor with a Medicare Advantage Plan will vary greatly depending on the policy. Some Medicare Advantage Plans may have a high annual deductible and copays. If you are eligible for a blood pressure monitor, it is best to check with your insurer to confirm what and how much would be covered.
Alternative Ways to Pay for Blood Pressure Monitors
Medicare will only pay for a blood pressure monitor if you are diagnosed with hypertension or receiving at-home dialysis treatments. If you want a blood pressure monitor outside of these circumstances, you may want to look into one of the following alternatives:
- Private health insurance: Private health insurance may offer more coverage in regard to blood pressure monitors. However, these plans will still have deductibles and copays for the covered device.
- HSA: An HSA is a health savings account used specifically for medical bills and services. If you have an HSA, you may look at pulling money from that account to cover a blood pressure monitor.
- Medicaid: Medicaid is a government-run health insurance program for low-income individuals. Medicaid may offer more coverage in regard to blood pressure monitors, but the plan is not available to everyone because of the strict income guidelines.
- Nonprofit organization: If you do not qualify for a blood pressure monitor in any other way, you may look into a nonprofit, such as the YMCA, to provide you with a free monitor.
- Renting: In the event you cannot afford to purchase a device, you may be able to rent a device from your physicians office or medical supply company. Keep in mind that the type of device you rent may lead to higher costs.
Putting It All Together
If you or someone you care about is a recipient of Medicare and suffers from hypertension, it is important to know how Medicare will cover a blood pressure monitor. Depending on your situation, Medicare Part A, Part B, and Part C may offer coverage. If you are ineligible for Medicare to cover an at-home blood pressure monitor, you may look into other options, such as your HSA or a non-profit organization.
If you suffer from hypertension, monitoring your blood pressure may be a crucial part of your health plan. It is important to understand your Medicare coverage to ensure you are receiving the best care possible.