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Does Medicare Cover High Cholesterol?


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Have you been diagnosed with high cholesterol levels in your blood? According to the Centers for Disease Control (CDC) in 2011-2012, about 37% of all adults in the United States had blood cholesterol levels that put them at increased risk for stroke and heart disease. If you’re covered under Medicare, here’s what you need to know about how Medicare pays for testing and treatment of high cholesterol.

What is high cholesterol?

Cholesterol, in and of itself, is not bad, according to the American Heart Association. In fact, your liver actually produces it and uses it to help build cells.

You also get cholesterol from the foods you eat, specifically animal products such as meat, eggs, and dairy. In some people, this dietary cholesterol causes the liver to make even more cholesterol than it normally would, leading to high cholesterol levels in the blood. Certain oils, such as palm oil and coconut oil, may also contribute to high cholesterol production.

You may have heard your doctor talk about “good” cholesterol and “bad” cholesterol. Low-density lipoprotein, or LDL, can build up on the walls of the arteries leading to higher risks for stroke, atherosclerosis, and heart attack, according to the American Heart Association (AHA). LDL is considered the “bad” cholesterol.

High-density lipoprotein, or HDL, actually helps sweep away LDL from the artery walls and back to the liver where it can be broken down and excreted from the body. This is the “good” cholesterol.

If you are diagnosed with high cholesterol, it generally means your LDL levels are above a healthy range. In adults age 20 and over, high cholesterol LDL levels are 160 mg/dL and above, according to the National Heart, Lung, and Blood Institute (NHLBI).

How is high cholesterol diagnosed?

Your doctor diagnoses high cholesterol using a simple blood test called a lipid panel. You will be asked to fast the night before your test. Your lipid panel shows the level of LDL and HDL in your blood, as well as your triglycerides, which are a type of fat stored in the cells for energy. Your total cholesterol score is the sum of your LDL and HDL, plus 20% of your triglycerides, according to the American Heart Association (AHA).

A total cholesterol score below 200 is within the healthy range, while a total score of 240 or more is considered high cholesterol and may increase your risk of health complications.

How is high cholesterol treated?

According to the NHLBI, your doctor may begin treating your high cholesterol with heart-healthy diet and lifestyle changes such as:

  • Reducing the amount of saturated and trans fats in your diet and increasing the amount of whole grains, fruits, and vegetables.
  • Increasing your physical activity through regular exercise.
  • Achieving and maintaining a healthy weight.
  • Giving up unhealthy habits such as smoking that may contribute to high cholesterol and other heart disease risks.

Depending on your cholesterol levels, your doctor may also recommend medications such as statins to lower your blood cholesterol. Although there are other high cholesterol medications, statins are the most common prescription drug therapy for people with high cholesterol, according to the NHLBI.

How does Medicare pay for high cholesterol?

Medicare generally covers routine high cholesterol screening blood tests once every five years at no cost to you if your provider accepts Medicare. If you are diagnosed with high cholesterol, Part B typically covers medically necessary blood work to monitor your condition and response to treatment. Medicare also covers any medically necessary doctor visits and outpatient tests to manage your high cholesterol; you generally pay 20% of the allowable charges under Part B after you meet your deductible. If you are hospitalized as a result of high cholesterol, Part A covers your inpatient care.

Part B also covers an annual cardiovascular disease risk reduction visit each year at no cost to you if your provider accepts Medicare assignment.

If you are overweight and need to lose weight to lower your cholesterol, you may also qualify for obesity screening and counseling sessions, again at no cost to you under Part B if your provider accepts assignment. Part B also covers up to eight smoking cessation sessions in each 12-month period at no cost to you.

Part B generally doesn’t cover any medications associated with treating high cholesterol. However, if you are covered under a Medicare Part D Prescription Drug Plan, most high cholesterol medications are covered. In addition to the monthly premium, be sure to check deductible, copayment and/or coinsurance amounts, especially for medications you take on a regular basis.

If you have a Medicare Advantage plan, you may have access to Silver Sneakers. This is a national senior exercise program giving you free access to participating gym facilities and exercise classes. If your doctor recommends exercise to help manage high cholesterol, the Silver Sneakers program may help you achieve your exercise goals.

Do you have any questions about Medicare coverage of high cholesterol? Feel free to use the eHealth plan finder tool on this page to browse Medicare plan options. Or, if you prefer to get personalized assistance, contact eHealth to speak with a licensed insurance agent. We can help you find Medicare plan options that address your Medicare needs.

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