Has your doctor diagnosed you with high cholesterol? High cholesterol can put you at an elevated risk for heart disease and stroke. If you have Medicare coverage, we’ll outline what you may need to know about how Medicare insurance pays for high cholesterol treatment and testing.

Defining High Cholesterol            

Not all cholesterol is bad, and your liver produces it to help build cells throughout your body. Meat, eggs, and dairy also give you cholesterol when you eat them. When some people eat a lot of meat, eggs, or dairy products, it prompts your body to make more cholesterol than you need, and this boosts your body’s levels.

There is good and bad cholesterol. Bad cholesterol is called low-density lipoprotein, or LDL. LDL can build up in your arteries on the walls, and this increases your risk for developing atherosclerosis, stroke, or heart issues.

High-density lipoprotein, or HDL, is the good cholesterol. This form of cholesterol helps remove LDL from your arterial walls. Once the LDL comes away from the walls of your arteries, it goes to your liver. The liver will break it down and excrete it to your body.

A high cholesterol diagnosis typically means your bad cholesterol levels exceed the healthy range set by the American Heart Association. For people who are 20 and up, you have high cholesterol if your levels are over 160 mg/dL.

Diagnosing High Cholesterol

Your doctor can find out whether or not you have high cholesterol by drawing blood and running a lipid panel. Starting at around midnight before the test, the doctor will ask you to fast. This blood test will show both the good and bad cholesterol levels in your blood. It’ll also show your triglyceride levels, and these are fat your body stores for energy.

The test will show you your total cholesterol score, and it encompasses both your LDL and HDL with 20% of your triglyceride levels. As long as this score is below 200, it’s in a healthy range. Having a total cholesterol score exceeds 240 is considered high.

Treating High Cholesterol

Your doctor may recommend lifestyle and diet changes to treat your high cholesterol. You may increase your vegetables and fruits while limiting your saturated fat. You should start exercising to reach a healthy weight and give up habits like smoking.

Medications are another option your doctor may recommend depending on how high your cholesterol levels are. Statins are the most common high cholesterol medication you can get, and this category includes Simvastatin.

How Medicare Coverage Pays for High Cholesterol Treatment

Generally, Medicare insurance will cover routine blood tests to check for high blood pressure once every five years. There will be no additional cost to you as long as the provider accepts Medicare. If your doctor diagnoses you with high cholesterol, Medicare Part B will cover any blood work that is medically necessary to monitor your cholesterol levels.

If you have medically necessary outpatient tests and doctor visits that help you manage your high cholesterol, Medicare will help cover them. However, you’ll usually pay 20% of your costs after you meet your Part B deductible unless you have secondary insurance. If you end up in the hospital as a result of your high cholesterol, Part A will help pay for your stay as long as you are formally admitted as an inpatient.

If the provider accepts Medicare assignment, Part B will pay for one cardiovascular disease risk reduction visit each year. They may pay for obesity screenings and counseling sessions if you have problems losing weight. Finally, Part B pays for eight smoking cessation sessions per year.

Medicare Part D may help pay for prescriptions you have as a result of your high cholesterol management plan. You do want to check your monthly premium, copay, deductible, and coinsurance for any medications you take regularly. Part D plans vary in cost and coverage, so check with your plan to check the formulary, or list of covered drugs, and your costs for a specific medication. Ask your doctor or pharmacist if you have any questions.

Many Medicare recipients choose to enroll in a Medicare Advantage plan, offered by a private insurance company. MA plans will include the same Part A and Part B coverage as Original Medicare, but many include additional benefits such as prescription drug coverage. Compare plans and consider your options before enrolling to find the coverage that’s right for you.

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