Does Medicare Cover BP Monitors?

Blood pressure is a big concern for many as we age. Several conditions, such as blood pressure and heart disease, require blood pressure monitoring.

The good news is that this is easier to do than ever. There are plenty of blood pressure monitors available in the market. However, they can be expensive.

Because of this, a very common question many seniors have is, “Does Medicare cover BP monitors?”

This article will answer this question in clear, plain English. You will also find the average costs of blood pressure monitors and other helpful info.

Does Medicare Cover BP Monitors?

The short answer is it depends. In most cases, Medicare will not cover the cost of blood pressure monitors. However, there are some situations where you can get these costs covered.

Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your blood pressure monitors.

Original Medicare Coverage of BP Monitors

Original Medicare (Medicare Part A and Part B) generally does not provide coverage for blood pressure monitors. So that means you will have to pay 100 percent for your blood pressure monitors.

Original Medicare does not provide coverage if you don’t need the BP monitor for a medically necessary reason.

However, Original Medicare may provide coverage for blood pressure monitors if it is done for a medically necessary reason.

When are BP Monitors Covered by Part A?

Coverage for blood pressure monitors is provided by Medicare Part A if you need a blood pressure monitor while in an inpatient setting.

When are BP Monitors Covered by Part B?

On the other hand, coverage for blood pressure monitors may fall under Medicare Part B when in an outpatient setting.

And for most individuals, this means needing to use the BP monitor at home. Part B may provide coverage for your at-home blood pressure monitor if you are on renal dialysis in your home or if your healthcare provider recommends an ambulatory blood pressure monitor.

If you are performing renal dialysis, Part B also covers blood pressure cuffs.

What Else Does Medicare Part B Cover?

Additionally, Part B covers the rental of an ambulatory blood pressure monitor once a year for two conditions:

For Medicare Part B to provide coverage for the rental of an ambulatory blood pressure monitor for Whitecoat syndrome, you must meet the standards of these criteria:

If your average systolic blood pressure is between 130 mm Hg and 160 mm Hg and your diastolic blood pressure is between 80 mm Hg and 100 mm Hg when checked at two separate doctor’s offices with at least two separate measurements taken at each visit;

And if your out-of-office blood pressure measured less than 130/80 mm Hg at two separate times.

Here are Medicare Part B’s criteria for them to provide coverage for the rental of an ambulatory blood pressure monitor for masked hypertension:

If your average systolic blood pressure is between 120 mm Hg and 129 mm Hg and your diastolic blood pressure is between 75 mm Hg and 79 mm Hg when checked at two separate doctor’s offices with at least two separate measurements taken at each visit;

And if your out-of-office blood pressure is measured at or more than 130/80 mm Hg at two separate times.

Medicare Part B provides coverage for blood pressure checks that takes place in a doctor’s office. Aside from that, Medicare Part B also has an annual wellness visit which includes blood pressure checks.

Once approved, Medicare Part B covers 80 percent of the costs of blood pressure monitors. You will pay for the remaining 20 percent.

Medicare Advantage Coverage of BP Monitors

Similar to Original Medicare, coverage for BP monitors by Medicare Advantage plans (Medicare Part C) will depend on the reason you need the monitor.

These plans cover everything Original Medicare covers and some additional benefits. However, coverage and out-of-pocket costs will vary depending on the plan providers provide.

How Much Does A Blood Pressure Monitor Cost?

Blood pressure monitoring kits usually cost somewhere from $19 to $100.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always be sure to double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.