Does Medicare Cover High Cholesterol?

Does Medicare Cover High Cholesterol?

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High cholesterol puts you at risk for heart disease, the leading cause of death in Americans. Health conditions considered as heart disease include coronary artery diseases, arrhythmia, congestive heart failure, and heart valve disease. The Centers for Disease Control and Prevention (CDC) reported that about 11.4% of people 60 years old and older have high cholesterol. If you have high cholesterol, know you’re not alone, as it is not an uncommon condition to have.

If you are 60 years or older, you’ll either be starting Medicare in a few years or already have it. With either situation, you’ll want to be getting ready for the cost of Medicare and how Medicare covers high cholesterol and heart disease.

Cardiovascular Disease Screening

Medicare covers several different screening services as preventive services. One of those screenings is cardiovascular disease screenings. This means you don’t have to have any symptoms to get this screening done. Medicare Part B will cover this blood work screening once every five years, and you should not pay anything for it.

This blood work screening checks your cholesterol levels as well as your lipid and triglyceride levels to help detect any signs of heart disease.

If your provider wants to do blood work more frequently because it is medically necessary to check those levels more often than every five years, it can be covered.

Medicare Coverage for Heart Attacks and Strokes

If you or someone you know has high cholesterol and experiences a heart disease condition, you’ll want to understand how Medicare covers it. Medicare Part B is your outpatient medical coverage. This means your doctor’s office visits, specialist visits, blood work, x-rays, CT scans, physical therapy, and outpatient surgery will be covered by Medicare Part B.

Part B has an annual deductible that you’d need to meet, which is $233 in 2022. After you meet your deductible, Medicare will cover 80% of the cost of your outpatient services. You’ll be responsible for the remaining 20% unless you have a Medicare Supplement or Medicare Advantage plan to help with your expenses.

If you are ever admitted as an inpatient, know that your inpatient stay will fall under Medicare Part A, which has a separate deductible. In 2022, that deductible is $1,556. However, when you add a Medicare Supplement or Advantage plan to your Medicare benefits, you may not be responsible for that amount.

Part D coverage for High Cholesterol

Since most people with high cholesterol take prescription medications to help lower those levels, you’ll want to know how your drugs can be covered. Original Medicare Parts A and B do not cover most prescription drugs, so you’ll want to purchase a Part D plan. Part D drug plans strictly only cover prescription drugs.

Statin Drugs

The most common types of drugs prescribed for high cholesterol are statins. There are six statin drugs: Atorvastatin, Fluvastatin, Lovastatin, Pravastatin, Rosuvastatin, and Simvastatin. Many of these have brand-name medications that some Part D plans can also cover.

Statin drugs help lower your low-density lipoprotein and increase your high-density lipoprotein. The low-density lipoprotein can build up in your arteries, leading to heart disease. Statins help your liver not create too much cholesterol when you have high cholesterol.

When choosing a Part D drug plan, you’ll want to ensure the plan covers your current medications. If your medications change, you can change your drug plan every year, so you always have the most cost-effective plan for your needs.

Final Point

Medicare covers medical services and prescription drugs to help with high cholesterol. The frequency and types of services you need all depend on your situation, but Medicare should cover any medically necessary service needed to treat, diagnose, or monitor a health condition.