Does Medicare cover cholesterol tests?

What cholesterol tests does Medicare cover?

Medicare Part B covers cardiovascular disease screenings, which check for problems with your heart and blood vessels and find out if you're at risk for heart disease. The screenings include blood tests for cholesterol, lipid and triglyceride levels to help detect conditions that may lead to a heart attack or stroke.

CMS's preventive services guide for providers says the covered screening lipid panel must include total cholesterol, HDL (high density lipoprotein) cholesterol and triglycerides, and that the screening is for people with Medicare Part B who don't have apparent signs or symptoms of cardiovascular disease.

How often does Medicare cover a cholesterol screening?

Medicare Part B covers the cardiovascular disease screening blood tests once every 5 years. CMS's national coverage determination for lipid testing says lipid testing in people without symptoms is considered screening, regardless of the presence of other risk factors such as family history or tobacco use.

What do I pay for a cholesterol test with Medicare?

You pay nothing for the cholesterol screening tests if your doctor or other qualified health care provider accepts assignment, and CMS lists no copayment, coinsurance or deductible for the screening. For diagnostic lab tests, Medicare.gov says you usually pay nothing for Medicare-covered tests and lists the Part B cost of covered clinical laboratory services as nothing.

Your doctor may recommend services that Medicare doesn't cover, or more often than Medicare covers them, which could mean extra costs for you. Ask your doctor why a test is recommended and what Medicare will cover. See what Medicare covers for blood work and lab tests.

Does Medicare cover cholesterol tests to diagnose or monitor a condition?

Medicare Part B covers medically necessary diagnostic laboratory tests when your health care provider orders them to help diagnose or rule out a suspected illness or condition. The cardiovascular disease screening is a different benefit: the once-every-5-years test for people without apparent signs or symptoms of cardiovascular disease.

For diagnostic lipid testing, CMS's national coverage determination for lipid testing (NCD 190.23) lists, under its indications, conditions in which lipid testing may be indicated, including:

• Assessment of patients with atherosclerotic cardiovascular disease.
• Evaluation of primary dyslipidemia.
• Any form of atherosclerotic disease, or any disease leading to the formation of atherosclerotic disease.
• Diagnostic evaluation of diseases associated with altered lipid metabolism, such as nephrotic syndrome, pancreatitis, hepatic (liver) disease, and hypo- and hyperthyroidism.
• Secondary dyslipidemia, including diabetes mellitus, disorders of gastrointestinal absorption and chronic renal failure.
• Signs or symptoms of dyslipidemias, such as skin lesions.
• As follow-up to the initial screen for coronary heart disease (total cholesterol plus HDL cholesterol) when total cholesterol is determined to be high (over 240 mg/dL), or borderline-high plus two or more coronary heart disease risk factors, or HDL cholesterol is below 35 mg/dL.

Does Medicare cover anything else to prevent heart disease?

Yes. Medicare Part B covers a cardiovascular behavioral therapy visit once a year with a primary care doctor or other primary care practitioner, in a primary care setting like a doctor's office. During therapy, your doctor may discuss aspirin use, check your blood pressure and give you tips on diet and exercise, and you pay nothing if your primary care provider accepts assignment. See whether Medicare covers an EKG.

Does Medicare Advantage cover cholesterol tests?

Medicare Advantage Plans must cover all medically necessary services that Original Medicare covers, and plans may also offer extra benefits that Original Medicare doesn't cover. Plans may have different out-of-pocket costs for certain services and may require you to use providers in the plan's network for non-emergency care, so check with the plan about where to get the test.