Does insurance cover blood pressure monitors? The Definitive Guide
Did you know that one in four adults worldwide has high blood pressure?
This condition can lead to serious health problems like heart disease, stroke, and kidney failure.
That is why it is important to monitor your blood pressure regularly and keep it under control.
But does insurance cover blood pressure monitors?
The answer is that it depends.
Different types of insurance have different coverage possibilities for home blood pressure monitors.
In this article, we’ll give you a clear and actionable guide to understanding your coverage options and getting the best deal for your health.
Types of Insurance Coverage
Three main types of insurance may cover blood pressure monitors: Medicare, private insurance, and Medicaid. Let’s look at each one in detail.
Medicare
Medicare is the federal health insurance program for people who are 65 or older, disabled or have certain chronic conditions.
Basic Medicare (Part A and Part B) does not cover home blood pressure monitors.
However, it may cover in-clinic blood pressure checks and ambulatory blood pressure monitoring (ABPM) rentals under specific conditions.
ABPM is a device that measures your blood pressure at regular intervals over 24 hours.
It can help diagnose high blood pressure or evaluate the effectiveness of your treatment.
To get Medicare coverage for ABPM, you need to meet the following criteria:
- You have suspected white-collar hypertension (high blood pressure only in the doctor’s office).
- You have suspected masked hypertension (normal blood pressure in the doctor’s office but high blood pressure elsewhere).
- You have high blood pressure that is resistant to treatment.
- You have hypotensive symptoms (low blood pressure) while using medication for high blood pressure.
If you have a Medicare Advantage plan (Part C), you might have different coverage for blood pressure monitors.
Medicare Advantage plans are offered by private companies that contract with Medicare.
They provide all the benefits of basic Medicare and may also offer extra benefits, such as vision, dental, hearing, and wellness programs.
Some Medicare Advantage plans may cover home blood pressure monitors as part of their wellness benefits.
To find out if your plan covers blood pressure monitors, you need to contact your plan provider and check your policy details.
Private Insurance
Private insurance is any health insurance that is not provided by the government.
It can be obtained through your employer, a marketplace, or directly from an insurance company.
Private insurance coverage for blood pressure monitors varies widely between plans and companies.
There is no standard or universal policy for covering home blood pressure monitors.
Some private insurance plans may offer full coverage for blood pressure monitors.
This means that they will pay for the entire cost of the device, as long as you have a prescription from your doctor and you buy it from an approved supplier.
Full-coverage plans may have specific benefits for home blood pressure monitors, such as:
- Preventive care benefits: These are benefits that cover services and devices that can prevent or detect health problems early. Some plans may include blood pressure monitors as part of their preventive care benefits.
- Chronic care benefits: These are benefits that cover services and devices that can help manage chronic conditions, such as high blood pressure. Some plans may include blood pressure monitors as part of their chronic care benefits.
Other private insurance plans may offer partial coverage for blood pressure monitors.
This means that they will pay for some of the cost of the device, but you will have to pay the rest.
Partial coverage plans may have different ways of sharing the cost with you, such as:
- Co-pays: These are fixed amounts that you pay for a service or device at the time of purchase. For example, you may have to pay $20 for a blood pressure monitor and your plan pays the rest.
- Deductibles: These are amounts that you have to pay for your health care before your plan starts to pay. For example, you may have to pay $500 for your health care in a year before your plan pays for anything.
- Reimbursement: This is when you pay for the full cost of the device upfront and then submit a claim to your plan for a partial refund. For example, you may buy a blood pressure monitor for $100 and then get $50 back from your plan.
Some private insurance plans may offer no coverage for blood pressure monitors.
This means that they will not pay for any of the cost of the device, and you will have to pay for it yourself.
No-coverage plans may have no benefits or exclusions for home blood pressure monitors.
For example, your plan may not cover any devices that are not medically necessary or prescribed by a doctor.
Medicaid
Medicaid is a joint federal and state program that provides health insurance for low-income and needy people.
Its coverage for blood pressure monitors depends on your state.
Each state has its own rules and regulations for Medicaid eligibility and benefits.
Recently, some states have changed their Medicaid policies to cover self-measured blood pressure (SMBP) for eligible patients.
SMBP is when you measure your blood pressure at home using a monitor and report the results to your health care provider.
SMBP can help improve blood pressure control and reduce healthcare costs.
As of January 2024, the following states have Medicaid coverage for SMBP:
- California
- Colorado
- Connecticut
Delaware - District of Columbia
- Hawaii
- Illinois
- Indiana
- Iowa
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Michigan
- Minnesota
- Mississippi
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Carolina
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Washington
- West Virginia
- Wisconsin
- Wyoming
If you live in one of these states, you may be able to get a blood pressure monitor through Medicaid if you meet the following criteria:
- You have a diagnosis of hypertension or prehypertension.
- You have a prescription from your health care provider for a blood pressure monitor and SMBP.
- You have a plan for SMBP that includes how often to measure, how to record, and how to share the results with your provider.
- You have a follow-up visit with your provider within six months of starting SMBP.
If you live in a state that does not have Medicaid coverage for SMBP, you may still be able to get a blood pressure monitor through other programs or options.
For example, some states may have special waivers or demonstration projects that cover blood pressure monitors for certain populations or conditions.
To find out if your state has any such programs, you need to contact your state Medicaid agency and check your eligibility and benefits.
Tips for Getting Coverage
As you can see, getting insurance coverage for blood pressure monitors can be complicated and confusing.
However, some tips can help you get the best coverage possible and save money on your device.
Here are some tips for getting coverage:
- Talk to your doctor. Your doctor can help you get a referral or recommendation for a blood pressure monitor that suits your needs and preferences. Your doctor can also prescribe the device and explain why it is medically necessary for you. Having a prescription and a letter of medical necessity can increase your chances of getting coverage from your insurance plan.
- Check your policy details. Before you buy a blood pressure monitor, you should check your insurance policy details and see what kind of coverage you have. Checking your policy details can help you avoid surprises and extra costs when buying a blood pressure monitor.
- Compare plans: If you are shopping for insurance, you should compare different plans and see which one offers the best coverage for blood pressure monitors.
- Consider alternative options: If you can’t get insurance coverage for blood pressure monitors or if you are not satisfied with your coverage, you can consider alternative options to get the device.
- Manufacturer rebates: Some blood pressure monitor manufacturers may offer rebates or discounts for their products. You can check their websites or contact their customer service to see if they have any such offers.
- Pharmacy programs: Some pharmacies may have programs that provide blood pressure monitors for free or at a low cost. You can check your local pharmacies or online pharmacies to see if they have any such programs
Conclusion
As you can see, getting insurance coverage for blood pressure monitors is not a simple yes-or-no question.
It depends on the type of insurance you have, the details of your policy, and the state you live in.
However, you can use the tips we shared to get the best coverage possible and save money on your device.
Remember, monitoring your blood pressure at home can help you prevent or manage high blood pressure and avoid its complications.
So don’t let the lack of coverage stop you from taking care of your health.
Check your coverage today and get a blood pressure monitor that suits your needs.
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I am Evans, an insurance expert with a deep-rooted passion for helping people understand the world of insurance. With about 2 years of experience, I’ve dedicated my career to simplifying complex insurance concepts and providing tailored solutions. I have the knowledge and expertise to guide individuals and businesses in making informed insurance decisions, thanks to my educational background in finance and risk management and my Bachelor’s degree in Insurance and Risk Management from Columbia University. I believe that insurance is not just about policies; it’s about safeguarding dreams and ensuring financial security. I’m committed to sharing my insights and knowledge to empower others to protect what matters most.