Medicare usually doesn’t cover at-home blood pressure monitors, except for home dialysis or when renting an ambulatory monitor once a year under specific doctor recommendations.
If your doctor recommends regular blood pressure checks, consider getting a home monitor.
The two main types of monitors are a blood pressure cuff, commonly used in doctors’ offices, and an ambulatory blood pressure monitor (ABPM), which automatically tracks your blood pressure for 24 hours.
That said, Original Medicare (parts A and B) covers at-home monitors only in specific cases. Read on to learn about their Medicare coverage.
Depending on the type of monitor, Medicare will only pay for an at-home blood pressure monitor in a few scenarios.
Dialysis
If you’re on renal dialysis at home, accurate and regular blood pressure monitoring is crucial. When you have chronic kidney disease, high blood pressure can decrease your kidneys’ ability to filter toxins out of your body.
For this reason, it’s important to know if your blood pressure is increasing. In this case, Medicare Part B will provide coverage for a manual blood pressure cuff and a stethoscope.
White coat syndrome and masked hypertension
There’s a phenomenon called white coat syndrome, which occurs when a trip to the doctor’s office—or just being in a doctor’s office—raises one’s blood pressure.
Medicare Part B will also cover the rental of an ABPM once a year when your blood pressure is measured at 130/80 to 160/100 millimeters of mercury (mm Hg) during at least two visits, but consistently measures below 130/80 mm Hg outside the office.
You can also experience masked hypertension, which means your blood pressure is lower in the doctor’s office than during daily life. Part B will also pay to rent a monitor when your systolic or diastolic blood pressure is measured between 120 and 129 mm Hg or between 75 and 79 mm Hg on two separate office visits, but your out-of-office blood pressure is consistently measured at 130/80 mm Hg or higher.
Other coverage
Part B also covers blood pressure checks that take place in your doctor’s office as long as your doctor is enrolled in Medicare. Your annual wellness visit should include a blood pressure check, which is covered under Part B as preventive care.
If you have a Medicare Part C (Medicare Advantage) plan, your plan should generally cover blood pressure monitors for use at home under the same criteria. This is because Part C plans must provide the same benefits as Original Medicare. Some plans will cover extra benefits, which means they may pay for monitors under additional circumstances as well.
If you have Medicare Part A, your benefits will cover any blood pressure monitoring needed while you’re an inpatient at a hospital.
Medicare doesn’t provide a home blood pressure monitor for free. Under Part B, Medicare will pay 80% of the cost of buying or renting either a manual monitor or an ABPM when you qualify for coverage under the approved criteria. You are then responsible for the remaining 20%.
That said, you’ll need to meet the Part B deductible of $257. You also have to pay a monthly premium, which starts at $185, depending on your income.
If you need monitoring while hospitalized, you must meet a $1,676 deductible. Once you do, Part A should cover this. Most people have no premium for Part A.
Part C plans are managed by private insurers and have different premiums, deductibles, and coinsurance, depending on your plan.
Many people buy blood pressure monitors online, from a local store, or from a pharmacy.
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It’s a good idea to research the manufacturers of cuffless blood pressure monitors, such as wrist and finger devices, as some brands
It’s also important to measure around your upper arm to ensure the cuff fits properly before making a purchase. It’s also advisable to bring your new monitor to your next appointment so your healthcare professional can check its accuracy.
You can purchase an ordinary cuff monitor from a pharmacy without a prescription. However, to get the cost reimbursed by Medicare, you will need a prescription or a letter from your doctor stating that the monitor is medically necessary.
While Medicare does not guarantee coverage for any particular brand of blood pressure monitor, it is more likely to cover validated brands such as Omron.
Whether or not you can get a home blood pressure monitor through Medicaid depends on your state.
Medicare does not pay for at-home blood pressure monitors unless you are undergoing renal dialysis in your home or if your doctor wants you to take your blood pressure somewhere other than a clinical setting.
If you are on at-home renal dialysis, Medicare Part B will pay for a manual blood pressure monitor and a stethoscope. If you have white coat syndrome or masked hypertension, Medicare will pay for you to rent an ABPM once a year to monitor your blood pressure over about 24 hours.
If you have a Medicare Advantage plan, you’ll need to find out whether your plan covers at-home blood pressure monitors. Each plan is different.
Taking your blood pressure home is a good idea, especially if you’re concerned about hypertension. You can find inexpensive blood pressure cuffs with a wide range of features online or in retail stores.