Does Medicare Cover Cholesterol Prescription Medications?

Pamela Cannaday by Pamela Cannaday | Licensed since 2011
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This article was updated on: 09/10/2018

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Cholesterol medications may help lower the risk of heart disease or stroke, according to the Food and Drug Administration. But the National Institutes of Health (NIH) points out that not everyone who has high cholesterol should necessarily take cholesterol medications.

What is cholesterol?

Before you decide to ask your doctor for a cholesterol medication, some background information can be useful. The NIH says that cholesterol is a waxy material that’s in all your cells. It helps our bodies make vitamin D and hormones, and aids digestion.

But there’s such a thing as too much blood cholesterol, namely LDL cholesterol, reports the NIH. That’s why doctors might prescribe cholesterol medications in some cases.

LDL stands for low-density lipoprotein. It’s one of the two kinds of cholesterol in your body; the other type is HDL (high-density lipoprotein). LDL is sometimes called “bad” cholesterol, because if you have too much of it in your blood, it can stick to your artery walls and might block them. This can result in various health problems, including a heart attack.

What are cholesterol medications?

If you have high cholesterol, your doctor might prescribe cholesterol drugs. A class of drugs called statins can reduce the amount of cholesterol that your liver produces, states the Food and Drug Administration. Statins can also help remove cholesterol already present in your blood.

Are cholesterol medications right for everyone with high cholesterol?

While cholesterol drugs may be appropriate for some people, the Mayo Clinic says that statins may have side effects, some of them serious. In some situations, the right diet and exercise may lower your cholesterol levels enough so that you won’t need cholesterol medications, according to the (NIH).

Whether you need cholesterol levels may depend on your risk level for a heart attack, the NIH reports. The American College of Cardiology and American Heart Association says you might benefit from statins if you have any of these health conditions:

  • Very high LDL levels (190 or higher)
  • Diabetes, together with an LDL level between 70 and 189
  • Cardiovascular disease
  • Risk of heart attack predicted to be 7.5% or higher in the next 10 years

Of course, you should discuss your particular health situation with your doctor so you can understand whether you may benefit from cholesterol medications.

Does Medicare cover cholesterol medications?

Original Medicare (Part A and Part B) won’t cover cholesterol prescription drugs in most situations. Part A (hospital insurance) might cover cholesterol drugs if they’re given to you as part of your treatment when you’re a hospital inpatient. Part B (medical insurance) generally covers only drugs that you wouldn’t normally take on your own, such as infusions of certain prescription drugs.

Cholesterol medications and Medicare Part D

Medicare Part D is Medicare’s prescription drug coverage program. Medicare Prescription Drug Plans are available through private insurance companies that contract with Medicare to deliver this benefit.

Every Medicare Prescription Drug Plan maintains its own formulary- this is a list of drugs the plan covers. If you’re looking for a plan that may cover cholesterol prescription drugs, you may want to take a look at the plan’s formulary to make sure the medication is covered. A plan’s formulary may change at any time. You will receive notice from your plan when necessary.

There are a couple of types of Medicare Prescription Drug Plans; I can explain them to you and help you find a plan in your vicinity that may cover your cholesterol medications. To arrange a phone call with me, or have me email you customized information about Medicare plan options, follow the links below. Anytime you’d like, you can look for Medicare Prescription Drug Plans on your own by clicking the Find Plans or Compare Plans buttons on this page.

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