How Does Medicare Cover Hypertension?

Hypertension is incredibly common in the United States, with nearly half of adults living with the condition. This is even higher in adults 60 and older with roughly 63 percent of this group having high blood pressure. Because such a large population lives with hypertension, especially older adults, it’s important to know what treatment options are available. In this article, we’ll discuss what your coverage options are so you can consider if you can afford the treatment. If you’re enrolled in Medicare, you should receive some coverage for hypertension.

Hypertension Prevention

One of the best ways to treat high blood pressure is to prevent it, and Medicare can help you here. Each year, Medicare entirely covers an annual Medicare wellness visit (along with a Welcome to Medicare visit when you first enroll), which is incredibly useful to check up on your general health. One of the health measurements taken during this visit is your blood pressure, and if you have (or are getting close to) hypertension, you can discuss lifestyle and health changes to make to minimize your risk.

If you qualify, Medicare may cover medical nutritional therapy or behavioral therapy to help you lose weight in a healthy way.

If you’re watching your blood pressure, Medicare has coverages that can make it easier to make lifestyle changes that may keep it in a healthy range. For example, if you smoke, Medicare can cover cessation counseling or even prescription cessation medication if it’s covered in your Medicare Part D formulary. Weight loss can lower your blood pressure, and Medicare can help with this, too. If you qualify, Medicare may cover medical nutritional therapy or behavioral therapy to help you lose weight in a healthy way. Some Medicare Advantage or Medicare Supplement plans may even cover gym memberships.

Original Medicare and Treatment

If you do develop hypertension, Medicare does have some treatment options that it covers. Under Original Medicare (and, by extension, Medicare Advantage), most of these treatments will fall under Medicare Part B outpatient coverage. It’s worth mentioning that the prevention methods covered above will also work as treatment options, and they will continue to be covered under Part B.

In fact, most non-drug treatment options relate to healthy lifestyle choices, so you’ll be working with your doctor to develop a plan. For example, if stress or mental health is a contributing factor to your high blood pressure, Medicare can help cover mental health services. Perhaps your physical health is contributing to your high blood pressure. If sleep apnea is a potential cause, Medicare can cover treatment. There is also a chance that Medicare may cover blood pressure monitors as durable medical equipment, if ordered by your doctor.

Once you meet your 2023 deductible of $226, Medicare will cover 80 percent of the approved amount and you cover the remaining 20 percent.

If your selected treatment is covered under Medicare Part B, what costs can you expect? First, you’ll need to meet your 2023 deductible of $226, Medicare will cover 80 percent of the approved amount. This means you’ll cover the remaining 20 percent. If you’re receiving your blood pressure treatment as part of inpatient care, it’ll be covered by Medicare Part A. In this case, you’ll need to meet your Part A deductible of $1,600 before it’s included in your daily coinsurance for days 61 to 90 ($400 per day).

Treatment Coverage in Medicare Part D

If you’re unable to control your blood pressure through a healthier lifestyle, your doctor may prescribe you medications. There are many different drugs that can help with both the causes and symptoms of hypertension, so your doctor will be able to figure out which to try for your situation. These drugs can include:

• Diuretics: Can remove excess salt and water and help control blood pressure.
• Beta-blockers: Lower heart rate and blood pressure.
• ACE inhibitors: Helps the blood vessel relax and open.

Depending on your Medicare Part D or Medicare Advantage drug plan, these prescribed drugs may be covered. It all depends on your formulary, which defines what drugs your plan covers and at what price point. Different plans will cover a different set of drugs and may cover them at different prices. If you have a hypertension drug prescription that’s not covered by your plan, it may be worth exploring your options.

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Hypertension is one of the most common health conditions in the United States. Through a combination of diet, exercise, and eliminating bad habits, you can keep your blood pressure at a healthy level. Sometimes, treatment or intervention by a doctor might be necessary. Medicare can make that help more affordable, lowering your chances of heart disease and other risks associated with hypertension.