A guide to managing high blood pressure with Medicare
High blood pressure is characterized by a high force of blood pushing against the walls of your arteries. While you don’t typically show direct symptoms of high blood pressure, it can lead to serious health problems.
The statistics around high blood pressure in America are astounding. According to the American Heart Association, more than 122 million people have high blood pressure (nearly half of Americans aged 20 and up).
And that’s not all. You’re more likely to experience high blood pressure as you age. In fact, more than three-quarters of Americans over the age of 65 have high blood pressure.
Given these high numbers, it’s a good thing that Medicare covers screenings, diagnosis, and some high blood pressure treatments. Learn about your coverage options for high blood pressure in this post.
Key takeaways:
High blood pressure can lead to serious health conditions like cardiovascular disease, diabetes, and heart failure.
Medicare covers preventative screenings, counseling sessions, rehabilitation programs, medications, and devices for high blood pressure or conditions related to high blood pressure.
What is high blood pressure?
Also known as hypertension, high blood pressure increases your risk of dangerous health issues, especially without intervention. The most common consequences of high blood pressure include:
Cardiovascular disease: High blood pressure can damage the arteries over time, which can lead to plaque buildup around the heart. Atherosclerosis (hardening of the arteries) can form as a result, which increases your risk of experiencing heart disease, a heart attack, and a stroke.
Diabetes: Studies show that people with hypertension could be more resistant to insulin, which can then lead to diabetes. Cardiovascular disease can also contribute to your risk of developing diabetes.
Heart failure: When you have high blood pressure, your heart has to work harder to pump blood. This can lead to heart failure, which occurs when the heart is unable to pump blood effectively.
Kidney damage: High blood pressure can damage the blood vessels in your kidneys, leading to kidney disease or failure.
Vision problems: Hypertension can affect the blood vessels in your eyes, which can result in vision issues or even blindness.
Aneurysms: High blood pressure can increase risk of aneurysms by weakening blood vessel walls. A ruptured aneurysm can be life-threatening.
The medical world also refers to high blood pressure as the “silent killer” because you don’t feel symptoms until you develop one of these more serious conditions. That’s why it’s important to take preventative measures and get regular screenings for high blood pressure.
What causes high blood pressure?
Many things cause high blood pressure, and most of the time you may get high blood pressure from a combination of factors. Here are some common contributors to the condition:
Genetics: If your parents or other family members have high blood pressure, you may be at an increased risk.
Age: Blood pressure can increase with age. The risk of hypertension is higher as you get older.
Lifestyle factors: Your diet, exercise, and level of obesity increases your risk of having high blood pressure. Eating too many sodium-rich foods and saturated fats can lead to hypertension. The same goes for not being physically active.
Smoking and drinking excessively: Smoking and drinking too much can raise blood pressure.
Stress: Chronic stress can contribute to high blood pressure, though the relationship between stress and hypertension is complicated.
Chronic kidney disease: Your kidneys help regulate blood pressure, so any condition that affects the kidneys, such as chronic kidney disease, can contribute to hypertension.
Hormonal factors: There are hormonal conditions, like primary aldosteronism or thyroid disorders, that can contribute to hypertension.
Certain medications: Some medications, including certain birth control pills, decongestants, and over-the-counter pain relievers, can increase blood pressure.
How do you treat high blood pressure?
Every person’s treatment plan for high blood pressure will look different depending on the cause, level, and symptoms. It typically involves a combination of making lifestyle changes, monitoring, and managing. Commitment is important to effectively treat and combat conditions that are related to blood pressure.
Here are some specific treatment options your healthcare provider can recommend:
Lifestyle modifications: Eating healthy, getting regular exercise, limiting alcohol consumption, and quitting the use of tobacco products can reduce your chances of developing high blood pressure.
Medications: Depending on your blood pressure levels and other health conditions, your doctor may prescribe medications to lower hypertension.
Regular monitoring: Monitoring blood pressure with a monitor at home or with your healthcare provider can help you track your progress toward reducing your blood pressure.
Relaxation techniques: Deep breathing, meditation, yoga, and mindfulness can help manage stress and keep high blood pressure at bay.
Treating other conditions: If kidney disease or a hormonal disorder causes your high blood pressure, addressing the underlying cause may be part of your treatment plan.
What does Medicare cover for high blood pressure?
There are several ways that Medicare provides coverage for high blood pressure and conditions associated with it. From preventative screenings to medication, we’ll break down all of your options.
Medicare coverage for screenings
Medicare Part B covers screenings for cardiovascular disease, diabetes, and alcohol misuse. It also covers a yearly “Wellness” visit. If you believe you have kidney disease, a hormonal disorder, or another condition that causes high blood pressure, Medicare will cover doctor visits to diagnose and treat these issues.
Cardiovascular disease screening: Medicare covers a blood test screening once every five years.
Diabetes screening: Medicare covers up to two blood glucose lab tests per year if you have high blood pressure.
Alcohol misuse screening: Drinking excessively can lead to high blood pressure. Medicare covers one alcohol misuse screening per year for people who use alcohol but aren’t alcohol dependent.
Yearly “Wellness” visit: Medicare covers a yearly “Wellness” visit where you can talk to your healthcare provider about any concerns you have with high blood pressure. Together, you can create a personalized plan to reduce your blood pressure.
Medicare coverage for counseling services
Depending on the cause of your high blood pressure, counseling services may help you manage it. Medicare covers:
Alcohol misuse counseling: up to four counseling visits each year
Behavioral therapy for cardiovascular disease: one visit per year
Nutrition therapy services: for people who have diabetes, kidney disease, or have had a kidney transplant recently
Obesity counseling: for people with a BMI of 30 or more
Tobacco cessation counseling: up to eight sessions in 12-months
Medicare drug coverage for blood pressure medications
Most Medicare drug plans cover medications to treat and manage high blood pressure. Check your drug formulary to see if your plan covers the drug your doctor recommends for you. If it isn’t covered, you can request a formulary exception, try a similar medication that your plan does cover, or change your drug coverage during the Annual Enrollment Period.
Medicare and cardiac rehabilitation programs
In more serious cases, high blood pressure and cardiovascular disease can lead to heart problems that require surgery. Medicare covers cardiac rehabilitation programs for the following situations:
You’ve had a heart attack in the last 12 months
You’ve had coronary artery bypass surgery
You’ve had a heart valve repair or replacement
You’ve had coronary angioplasty (a medical procedure to open a blocked artery) or coronary stent (a surgery to keep an artery open)
You’ve had a heart or heart-lung transplant
You have stable chronic heart failure
These programs include exercise support, education, and counseling for people with serious heart issues. If you use a cardiac rehabilitation program, you’ll pay 20% of the cost of the service after you meet your Part B deductible.
Does Medicare cover blood pressure monitors?
An ambulatory blood pressure monitor (ABPM) is a portable device that you wear on your arm. It automatically takes your blood pressure at regular intervals over a 24-hour period. This gives you a more comprehensive understanding of your blood pressure throughout the day and night.
Medicare only covers blood pressure monitors for at-home use under specific circumstances. You can get the device covered if:
You are on renal dialysis in your home
Your doctor recommends a blood pressure monitor for consistent measurements. This can happen when the machine reads higher numbers at the doctor’s office but lower at other times, or when your blood pressure is high at home but low at a healthcare facility.
If you’re eligible to get an ambulatory blood pressure monitor covered, you’ll pay 20% of the cost of the device after you meet your Part B deductible.
Does Medicare cover blood pressure cuffs?
Medicare does not typically cover blood pressure cuffs. However, some Medicare Advantage plans offer flex card benefits. These are flex spending credits that you can often use to pay for over-the-counter (OTC) items, including blood pressure cuffs. Check your summary of benefits to see if your plan includes flex credits.
For an even easier solution, you can also use Chapter’s free app to keep track of your credits and make sure you use them before they expire.
How else your Medicare plan can help
High blood pressure can lead to many more serious health complications. There are many ways your Medicare benefits can help, but it isn’t always easy to navigate your plan’s coverage for blood pressure services. Talking to a licensed Medicare Advisor is a good way to understand how your plan can pay for the services you need to manage and treat high blood pressure. Call 855-900-2427 or schedule a time to talk about your unique healthcare needs.