Roughly one in three adults in the U.S. is diagnosed with hypertension, or high blood pressure. Medicare manages coverage for high blood pressure according to the type of service, medication or piece of equipment is medically necessary for treatment.
Understanding High Blood Pressure
The American Heart Association considers high blood pressure a silent but deadly health threat — the condition has very few symptoms but can cause a lot of other complications. The conundrum this poses is part of the reason why a blood pressure check is one of the first and most common diagnostic tests at a variety of medical appointments.
Blood pressure is the measure of how well the heart is able to pump blood and drive the circulatory system through its cycle. Systolic pressure, when the heart beats, and diastolic pressure, when the heart rests, work together to fuel circulation. When they have to work too hard to maintain that cycle, pressure against the walls of the veins and arteries rises, thus leading to high blood pressure readings.
This table shows how health professionals categorize different blood pressure readings:
| Classification | Systolic (upper number) | Diastolic (lower number) | |
| Normal | lower than 120 | and | lower than 80 |
| Elevated | 120-129 | and | lower than 80 |
| Hypertension Stage 1 | 130-139 | or | 80-89 |
| Hypertension Stage 2 | 140 and higher | or | 90 and higher |
| Hypertensive Crisis | 180 and higher | and/or | 120 and higher |
Genetics and preexisting medical conditions can cause hypertension, but many lifestyle choices can lead to high blood pressure, too. Excessive substance use and abuse, particularly alcohol and tobacco, as well as an unhealthy diet with too much salt, can all contribute to the development of hypertension.
Medicare Coverage for High Blood Pressure
High blood pressure checks are a part of every routine medical visit, which are covered by Medicare Part B benefits. Health care professionals will perform the usual diagnostic process of taking your blood pressure and inquiring about any significant risk factors, such as family history or lifestyle choices.
If it’s determined that you meet the definition of high blood pressure or hypertension, your physician may advice you to pursue a number of treatment options. When your physician finds it medically necessary and Medicare Part B’s policies allow for it, you can receive supportive services that help you identify health goals, such as reducing sodium or quitting tobacco use.
Medicare Part B also provides coverage for durable medical equipment in cases where a recipient needs access to a blood pressure monitoring cuff in the home, but recipients may need to prove the medical necessity exceeds certain limits. Medication to help manage high blood pressure is not typically covered by Original Medicare Parts A or B unless it’s being administered to a recipient who is a qualified inpatient at a hospital.
Medicare recipients who have a Medicare Part D Prescription Drug Plan, whether it’s standalone or within a Medicare Part C Medicare Advantage bundle, should consult their plan’s formulary for specific coverage information when it comes to blood pressure medication. Medicare Part D plans may charge copays according to the cost tier assigned to that medication.
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