Does Medicare Cover Blood Pressure Monitors?

Key Takeaways

These days, more and more people are tracking their health and fitness metrics. They're using smart watches to measure heart rate, track exercise, and monitor sleep patterns. However, many of the popular smart watches do not provide accurate results when it comes to measuring blood pressure.

Nearly half of U.S. adults have high blood pressure, or hypertension. Many times, hypertension has no obvious symptoms. That's why regular blood pressure checks are key to detect hypertension early and prevent serious health problems like stroke and heart attack.

Adults over 40 should get their blood pressure checked annually, but people at risk for hypertension may want to check more frequently. You may be wondering if you can get a reliable home monitor through Medicare. This post will provide you with all the information you need to navigate coverage.

Types of Home Blood Pressure Monitors

First, let’s look at some common home blood pressure monitors. The first is an ambulatory blood pressure monitor, or ABPM. It measures blood pressure at regular intervals over several hours or days. It consists of a cuff that you wear on your arm and a recording device that can be clipped to your belt or clothing. You wear the device for up to 48 hours while asleep and awake. This helps give your healthcare provider a fuller picture of your blood pressure patterns than a single measurement in a clinic or hospital.

The second type is an over-the-counter blood pressure monitor. There are various types of these products on the market, including a wrist cuff, upper arm cuff, and finger monitors. However, only an upper arm cuff monitor is recommended by the American Heart Association. These types of monitors are sold in pharmacies and online.

Medicare Coverage of Ambulatory Blood Pressure Monitors (ABPM)

Typically, Medicare Part B will not cover the cost of an ABPM unless it's deemed medically necessary. According to the Centers for Medicare and Medicaid Services (CMS), Medicare must cover an ABPM up to once per year if you have one of the below conditions (click here for the exact circumstances for coverage by Medicare.)

• Masked hypertension - people with masked hypertension have normal blood pressure at the provider's office but have elevated blood pressure in other settings.
• White coat hypertension - people with white-coat hypertension experience higher than normal blood pressure in the provider's office, but not in other settings.

Original Medicare would cover the ABPM under Medicare part B only when medical necessity criteria is met and prior authorization is approved. Medicare Part B would pay for 80%, and you would be responsible for the other 20%. Your Part B premium, and deductible may apply.

A Medicare Advantage plan, also known as Part C, is an alternative to Original Medicare. It offers the same Part B coverage, and depending on the plan it may also offer some extra benefits.

Medicare Coverage of Over-the-Counter (OTC) Blood Pressure Monitors

Original Medicare doesn't cover OTC blood pressure monitors. Similarly, Medicare Advantage would not cover an OTC blood pressure monitor, but depending on the plan, there may be an OTC allowance benefit. For example, some Wellcare Medicare Advantage plans come with the Wellcare Spendables® debit card to use on health items you need, including approved home blood pressure monitors. These funds vary based on the Wellcare plan you choose.

Tips for Buying a Blood Pressure Monitor

You can also buy an ABPM from your local pharmacy or online. They can cost anywhere from about $50 to $100. Keep the following tips in mind when shopping:

• The American Heart Association (AHA) recommends an automatic monitor with an upper arm cuff.
• The AHA doesn't recommend wrist and finger monitors because their results are not as reliable as the upper arm monitors.
• Check that the monitor meets the U.S. Blood Pressure Validated Device Listing criteria. See https://www.validatebp.org for more information.
• Measure around the upper arm and choose a monitor that comes in the correct cuff size.
• Check your monitor's reading against your healthcare provider's reading when the device is new. Check it once a year after that.
• Monitors can wear out over time. You may have to replace your monitor if the measurements are very different from the measurements made at your provider's office.

Other Options for Blood Pressure Monitoring

If you don't have a home blood pressure monitor, there are still ways you can check your blood pressure yourself for free. Many pharmacies, grocery stores, and shopping centers will have a blood pressure cuff machine available for public use. You can also find them at many health fairs and community health centers.

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Do I need a prescription for a blood pressure monitor to be covered by Medicare?

Yes, you need a prescription and proof of medical necessity from your healthcare provider in order to have a blood pressure monitor covered by Medicare.

What if I don't have a prescription for a home blood pressure monitor?

You can purchase a home monitor over-the-counter from your local pharmacy or online. Costs range from $50-100 or more. You can also find free blood pressure machines at some pharmacies and local health centers.

How do I check my blood pressure at home?

This video shows you step-by-step how to measure your blood pressure at home.

Sources:

• CMS National Coverage Analysis (NCA) Decision Memo
• Medicare.gov Durable Medical Equipment (DME) Coverage
• Cedars-Sinai: White-Coat Hypertension and Masked Hypertension
• Krames by WebMD Ignite: High Blood Pressure/Hypertension
• Krames by WebMD Ignite: Checking Your Blood Pressure at Home
• Take the Blood Pressure Quiz
• Krames by WebMD Ignite: Step by Step: Checking Your Blood Pressure
• Office of Disease Prevention and Health Promotion: Get Your Blood Pressure Checked

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