Does Medicare Cover Cholesterol Testing?

Last Updated : 09/10/20184 min read

According to the National Institute of Health’s National Heart, Lung, and Blood Institute, heart disease is the leading cause of death in the United States. In fact, in 2010, heart disease was responsible for 32% of all deaths in the U.

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If you are enrolled in Original Medicare (Part A and Part B) and your doctor orders cholesterol testing to determine your risk for heart disease, Medicare will pay for the test, as well as lipid and triglyceride level tests, once every five years. You generally pay nothing out of pocket for these tests.

Why did my doctor order cholesterol testing?

The National Heart, Lung, and Blood Institute (NHLBI) lists high cholesterol as a leading risk factor for heart disease. Other risk factors include:

  • High blood pressure
  • Diabetes
  • Obesity
  • Smoking
  • Sedentary lifestyle
  • Poor diet
  • Stress

Cholesterol testing helps your doctor determine your overall risk for developing heart disease. The higher your cholesterol and other risk factors, the higher your chances of getting heart disease or having a heart attack, says the National Heart, Lung, and Blood Institute. The NHLBI recommends that everyone age 20 and over have cholesterol testing at least once every five years.

How does cholesterol testing work?

Cholesterol testing is typically performed with a simple blood test known as a lipoprotein panel. You will be instructed not to eat or drink anything for 9 to 12 hours before the test. The test results will tell your doctor:

  • The total amount of cholesterol in your blood.
  • How much LDL cholesterol is in your blood. LDL is considered the “bad” cholesterol because it is the main source of the waxy buildup in your arteries that causes blockage.
  • How much HDL cholesterol is in your blood. HDL is the “good” cholesterol because it actually removes the “bad” cholesterol from your blood.
  • The amount of triglycerides in your blood. Triglycerides may be associated with a higher risk of heart disease, especially if you are a woman.

According to the NHLBI, total cholesterol below 200 mg/dL is desirable, while 240 mg/dL and above is considered high.

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LDL, or bad cholesterol, below 100 mg/dL is optimal, while 160 mg/dL and above is considered high.

HDL, or good cholesterol, is actually protective against heart disease at levels of 60 mg/dL and above, while numbers below 40 mg/dL are considered a major risk factor for heart disease.

What if my cholesterol testing is high?

Your doctor may recommend different treatments depending on your cholesterol numbers and other lifestyle and risk factors. According to the NHLBI, a low-cholesterol diet, achieving and maintaining a healthy weight, regular exercise, and even cholesterol-lowering medications may all be appropriate treatments for high cholesterol. Only your doctor or other health-care professional can determine which treatments are best for you.

If you have high cholesterol or other risk factors for heart disease, or are currently under a doctor’s care for these conditions, a Medicare Supplement plan, or Medigap plan, may help you better manage the out-of-pocket costs associated with your medical treatment. Medicare Supplement plans pay all or part of your Part A and/or Part B deductibles and coinsurance amounts.

Medicare Advantage plans (Part C) may also make sense for you. Medicare Advantage plans are offered by private insurance companies approved by Medicare. By law, they must cover everything that Original Medicare covers (except for hospice care, which is still covered under Part A), but they may also offer additional benefits to help manage your health-care costs.

For example, most Medicare Advantage plans include Part D coverage for prescription drugs, possibly including drugs to lower your cholesterol. They may also offer coverage for routine vision, dental, and hearing care. Some plans may even include discounted gym memberships and wellness programs that may help you manage your cholesterol.

Still have questions about Medicare and cholesterol testing?

Want to know more about Medicare options for cholesterol and heart disease? I am happy to answer your questions. If you prefer, you can schedule a phone call or request an email by clicking on the buttons below. You can also find out about plan options in your area by clicking the Compare Plans button.

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