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Does Medicare cover Cholesterol testing?


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A cholesterol test can be one of the screenings your doctor arranges at a regular checkup, according to the American Heart Association. A cholesterol test can help identify problems. In some cases, Medicare may cover cholesterol testing.

Cholesterol tests: some facts

Did you know that nearly one out of three Americans has high cholesterol? Specifically, they have high levels of “bad” cholesterol. That’s what the American Heart Association (AHA) reported in 2018. We’ll look into what that means.

There are two types of cholesterol, the AHA explains. High-density lipoprotein (HDL) is sometimes called “good” cholesterol. Scientists believe HDL helps remove “bad” cholesterol from the arteries. That “bad” cholesterol is low-density lipoprotein (LDL), which can build up along the walls of your arteries.

So, to expand on the AHA’s report – nearly one in three Americans has high LDL levels, and about 18.7% have low HDL levels.

According to the Centers for Disease Control (CDC), the figures below are considered healthy cholesterol levels. Doctors measure cholesterol levels in milligrams (mg) of cholesterol per deciliter (dL) of blood.

  • LDL level: less than 100 mg/dL
  • HDL level: 40 mg/dL or higher
  • Total cholesterol: Less than 200 mg/dL

Cholesterol tests: why are they necessary?

High cholesterol (high LDL levels) can lead to heart disease and stroke, according to the CDC. That’s because of the way cholesterol can accumulate along artery walls, making them narrow. On the other hand, the American Heart Association, HDL (“good”) cholesterol can protect against heart disease, so low HDL levels may also increase the risk of heart disease or stroke.

Why might you need a cholesterol test? The CDC reports that there are no symptoms you can rely on to signal that you have high cholesterol.

Does Medicare cover cholesterol tests?

Medicare Part B (medical insurance) generally covers a cholesterol test once every five years. You typically don’t have to pay for this test. However, you might pay a deductible or coinsurance for the doctor visit itself, or other medical services related to your health condition.

If you have a Medicare Advantage plan, it typically covers a cholesterol test every five years, since Medicare Advantage plans deliver your Medicare Part A and Part B benefits through private insurance companies that contract with Medicare.

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