Home-based blood pressure monitors, sometimes known colloquially as cuffs, aren’t typically covered by Medicare. Ambulatory blood pressure monitoring devices (ABPMs) aren’t usually covered, either. There are two exceptions, however.
The first exception involves a blood pressure monitor and stethoscope for a Medicare beneficiary who is undergoing dialysis at home. It can be either hemodialysis or peritoneal dialysis. The second is an ambulatory blood pressure monitoring device (ABPM). This device takes and stores blood pressure readings in 24-hour cycles. The ABPM must be recommended by a doctor who believes that a patient has artificially inflated blood pressure readings when taken in a doctor’s office. This condition is sometimes called white coat hypertension. Medicare may cover at-home testing if the doctor’s recommendation is based on multiple testing sessions both in and out of a doctor’s office setting.
As with all Medicare coverage issues, the trick is figuring out whether or not Medicare deems the equipment “medically necessary.” In a nutshell, this means that the use of a home blood pressure monitor must be prescribed by a doctor and that Medicare concurs with the doctor’s analysis. Additionally, the equipment must be provided from an authorized equipment supplier.
How much is covered
If Medicare determines that either of the aforementioned instances will be covered, the cost of renting the blood pressure monitoring device will be handled by Medicare Part B. The only stipulation is that the blood pressure monitor must be rented from a Medicare-certified medical equipment supplier.
Medicare Part B pays 80% of the Medicare-approved amount for the blood pressure monitor device rental. That means that the patient is responsible for the remaining 20%. You must make sure to rent the monitor device from an equipment supplier who is approved by Medicare and classified as a participating supplier. If you rent the equipment from an unapproved supplier, they may charge more than the Medicare-approved amount. That can lead to significant out-of-pocket costs as opposed to the 20% of a pre-approved amount that is guaranteed if you deal with an approved supplier.
What if you have Medicare Advantage (also called Medicare Part C) instead? These plans are required by law to cover everything that is included in Original Medicare Part A and Part B plans. So if you have a Medicare Advantage plan, you will still be eligible for the blood pressure monitoring exceptions listed above. Some Advantage plans offer coverage extras above and beyond Part A and Part B, either in the form of expanded amounts of coverage or expanded coverage areas. If you have an Advantage plan, you should contact the plan administrator to determine any extra benefits that you may be eligible to receive. You may also have different co-payments, depending on a range of plan and provider variables.
If you have questions about procuring a home-based blood pressure monitor and whether or not Medicare will cover the costs, you may contact them directly at 1-800-633-4227.