Medicare patients looking for coverage on blood pressure monitors are part of a growing group. Health care physicians are telling more of their high-blood pressure patients to continue to check their numbers at home. Doing so may result in a more accurate reading.
Medicare coverage for blood pressure monitors is available for those who qualify. Using an at-home BP device, patients can log numbers multiple times a day. When a patient only gets a BP reading from their health care provider, it gives a less accurate number.
Daily at-home BP tracking also shows how a patient may be responding to a certain medication or BP treatment. In some cases, doctors may suggest using an at-home device to record blood pressure readings and any reactions to medications.
Understanding your coverage isn’t always clear, specifically about the different types of medical equipment and supplies. However, Medicare coverage for blood pressure monitors is only available for eligible beneficiaries.
Medicare Coverage for Blood Pressure Monitors
For some, an ABPM is necessary in order to maintain a healthy lifestyle. Medicare coverage for blood pressure monitors is available for qualifying beneficiaries in exceptional situations. However, your healthcare provider must first document it’s “medically necessary”.
The plan must also agree the equipment/care is medically necessary to treat your condition. Any ABPMs or care must come from a provider or supplier that is participating in Medicare. Depending on how and where you get your treatment/health care, Medicare Part A, Part B or Part C may cover the costs.
One of the most important health signs to keep track of is your blood pressure. As this is the force of blood that keeps it flowing throughout the body via the circulatory system. Maintaining your BP is vital to your overall health.
Using a blood pressure monitor can be a useful tool in tracking your daily health. When a spike in your BP number occurs, an underlying health condition may be the cause.
To measure blood pressure there are 2 main types of devices. One is also known as a cuff and the other an ambulatory blood pressure monitoring (ABPM) device. Doctor’s office or hospitals often use blood pressure cuffs. Whereas ABPMs is for at-home use.
Part A – After a patient is admitted to a Medicare-approved hospital, Part A will help cover the cost of expenses for care – this includes blood pressure monitoring. Medicare Part A covers most hospital services and treatments.
Part B – Preventive care and any services or supplies that are medically necessary to fall under Part B coverage. During routine office visits, your blood pressure will be taken at least once. Patients must meet a certain criterion, for at-home blood pressure monitor coverage.
Currently Receiving At-Home Dialysis Treatments
If you’re currently receiving at-home dialysis treatments, coverage for an at-home BP monitor may be available. Dialysis patients may receive a “cuff” and a stethoscope to monitor their blood pressure and heart rate during treatment.
Although, if a healthcare provider certifies that a patient has inaccurate readings in an office or other medical facilities, Medicare may cover at-home BP monitors. This condition is otherwise known as white coat hypertension.
In such cases, doctors hope to receive a more realistic reading from the patients ABPM device. These devices take at-home readings several times during a 24-hour period.
Eligible enrollees may not have end-organ damage. Additionally, patients must have had at least 3 doctor’s in-office visits and 2 out-of-office readings have been >140/90mm Hg (and documented) to be eligible for Part B coverage.
Qualifying beneficiaries must pay 20% of the Medicare-approved amount for the blood pressure monitor device rental. Part B covers the other 80% of the costs. This is providing the beneficiary rents the device from an approved supplier. Renting equipment from a non-approved supplier may result in large out-of-pocket costs.
Part C Coverage for BP Monitors
Medicare Part C – Known as Medicare Advantage plans, Part C allows you to receive benefits through a private insurance company. Companies have contracts with Medicare that offer you the same benefits Parts A and B provide. Although, most Advantage plans provide additional benefits to members at little or no extra expense.
Advantage plan beneficiaries should check to ensure their policy allows renting or buying a blood monitor to use in their home. Plans may require the equipment to come from a Medicare-approved supplier, and they must accept Medicare assignment.
Meaning, these suppliers agree to charge a specific price that Medicare predetermines. Advantage plan enrollees may need to get their devices through an in-network supplier. Otherwise, coverage may not apply, and out-of-pocket expenses will be the patient’s responsibility.
Benefits will vary by plan; members should contact their plan directly to determine coverage or cost responsibility. Remember to inquire about deductibles, copayments, coinsurance and premium costs. Your plan should tell you if blood pressure monitor devices are under your plans’ coverage policy.
How Blood Pressure Monitors Help Manage Hypertension
If you have high blood pressure, you should monitor your blood pressure at home – according to the American Heart Association (AHA). Monitoring your BP at home can help your doctor provide more effective treatment.
Although, visiting a doctor is necessary and using at-home treatments should never replace those visits. Your hypertension should be regularly recorded by a health care provider.
However, the reading from the doctor’s office is just a small incite to your true condition. Providing your doctor with daily tracking of your BP gives them more information to work with.
This gives your doctor a better overview of how your blood pressure may be responding to a medication or treatment.
How to Use a BP Monitor
The AHA states that models with an upper arm cuff give the most reliable BP readings. Additionally, the wrist/fingertip BP monitors tend to give a less accurate reading.
Bringing your blood pressure monitor to your doctors’ visit is a good idea. This can help your healthcare provider ensure you’re using the equipment properly. This also allows your doctor to compare readings to those taken in the office.
To get the best reading, take your blood pressure at the same time daily. Using a journal for blood pressure results, record 2 or 3 readings – about a minute apart. Then, bring this journal to your doctors’ visits to discuss the results.
Before taking your blood pressure, try not drinking caffeine, exercising or smoking for a minimum of 30 minutes. During the reading, make sure to sit straight up with your feet flat on the floor. Do not cross your legs and try to remain still. Resting your arm on a flat surface, your upper arm should be level with the heart.
Check the BP cuff, it must be just above the crease of the elbow for a proper reading. Wait 5 minutes after an abnormal or high reading, then try again. If multiple readings are high, call your doctor for further instructions.
BP Monitors and Medigap
Medicare Supplement Insurance Plans or Medigap policies may cover all or some of the costs of medical expenses. Medigap may also cover other similar out-of-pocket costs that Part A and B don’t cover.
Understanding coverage or what plan is right for your health care needs can be confusing. Don’t worry seniors, we’re here to help you! Give us a call today at the number provided above. One of our licensed Medicare agents will be happy to walk you through the process.
You may find your current policy doesn’t offer the coverage you need for treating your condition, our agents can help. Comparing rates and providing all available options, let us help find the right plan for you.