Medicare's coverage of blood pressure monitors depends on the type of device and how your doctor prescribes it

Medicare Part B covers a blood pressure monitor only when your doctor orders it as durable medical equipment (DME) for use at home. This means your doctor must write an order stating that the monitor is medically necessary for your condition — not straightforward that you want one to track your health. Medicare will not pay for a monitor you buy on your own, even if you have a diagnosis like hypertension.

The device must also meet Medicare's standards for DME. Most automatic arm cuffs and wrist monitors sold in drugstores do not may have access to. Medicare typically covers only certain clinical-grade devices that your doctor has specifically prescribed.

If your doctor does prescribe a covered monitor, you will work with a Medicare-approved DME supplier. Medicare pays 80 percent of the approved amount after you meet your Part B deductible. You pay the remaining 20 percent.

Key Takeaways

  • Your doctor must write a prescription for the blood pressure monitor and state that it is medically necessary for your condition.
  • You must obtain the monitor from a Medicare-approved DME supplier, not from a retail store or online retailer.
  • Medicare covers 80 percent of the approved cost after your Part B deductible is met; you pay 20 percent.
  • Most over-the-counter blood pressure monitors do not meet Medicare's coverage standards, even if you have high blood pressure.
  • If your doctor does not prescribe one, you can purchase a monitor yourself, but Medicare will not reimburse you.

When a doctor will prescribe a blood pressure monitor

Doctors typically prescribe a home blood pressure monitor when they need you to track readings over time for medical reasons. This is most common if you have been recently diagnosed with high blood pressure, if your readings are unstable, or if your doctor is adjusting your blood pressure medication and needs to see how it is working.

A prescription is less likely if your blood pressure is stable and well-controlled on your current medication. In that case, your doctor may straightforward recommend that you monitor it yourself using a device you purchase, without writing a formal order.

Some doctors also prescribe monitors for patients with heart disease, kidney disease, or diabetes, where tracking blood pressure at home gives important information between office visits.

How to get a Medicare-covered blood pressure monitor

If your doctor believes a home monitor is medically necessary, ask them to write a prescription for DME. The prescription should specify the type of monitor and state why you need it.

Once you have the prescription, contact a Medicare-approved DME supplier. You can find suppliers in your area by visiting the Medicare website or calling 1-800-MEDICARE. Give the supplier your prescription and Medicare information. The supplier will verify your coverage, tell you what your out-of-pocket cost will be, and arrange delivery of the device.

The entire process usually takes one to two weeks. Some suppliers can expedite delivery if your doctor indicates the need is urgent.

What Medicare does not cover

Medicare does not cover blood pressure monitors purchased from retail stores, pharmacies, or online retailers — even if you have a diagnosis of high blood pressure. This includes popular brands sold at drugstores and big-box retailers. The reason is that Medicare only reimburses for devices ordered through the DME process, which ensures the device meets clinical standards and is appropriate for your specific medical situation.

Medicare also does not cover monitors for general wellness or prevention if you do not have a medical condition that requires home monitoring. If your doctor straightforward recommends you keep track of your blood pressure as a healthy habit, that falls outside Medicare coverage.

Replacement monitors are covered only if your original device breaks or becomes unusable and your doctor writes a new prescription.

Your out-of-pocket costs

If Medicare covers your blood pressure monitor, you will owe 20 percent of the approved cost after you meet your Part B deductible for the year. The approved cost varies depending on the type of monitor, but clinical-grade automatic monitors typically range from $50 to $150 in approved amount, meaning your 20 percent share would be roughly $10 to $30.

If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower. Medigap plans often cover the 20 percent coinsurance. Medicare Advantage plans have their own cost-sharing rules, which vary by plan.

If you choose to buy a monitor yourself without a prescription, you pay the full retail price out of pocket. Drugstore monitors typically cost $30 to $80.

Talking to your doctor about home blood pressure monitoring

If you have high blood pressure or a condition that affects your heart or kidneys, ask your doctor whether home blood pressure monitoring would help your care. Be specific: ask whether they think it is medically necessary and whether they would prescribe a monitor through Medicare.

If your doctor says no, you can still purchase a monitor on your own. Many people find that tracking their own readings helps them stay motivated to take medication and make lifestyle changes, even if Medicare does not pay for it.

If your doctor says yes, ask them to write the DME prescription before you contact a supplier. This prevents confusion and speeds up the process.

Frequently Asked Questions

Can I use my own blood pressure monitor instead of one prescribed by my doctor?

Yes. You can buy and use any monitor you choose. Medicare straightforward will not pay for it unless your doctor has prescribed it as DME. Many people use drugstore monitors successfully. If you do, ask your pharmacist or doctor which brands are known to be accurate.

What if my doctor prescribed a monitor but my DME supplier says Medicare will not cover it?

Contact your doctor's office and ask them to appeal the denial or to clarify the medical necessity in writing. You can also call 1-800-MEDICARE to ask why the claim was denied. Sometimes the issue is that the specific brand or model does not meet Medicare standards, and your doctor can prescribe a different one that does.

Will Medicare pay for a wrist or finger blood pressure monitor?

Wrist and finger monitors are rarely covered by Medicare because they are considered less accurate than arm cuff monitors. If your doctor prescribes one, Medicare may still deny it. Arm cuff monitors are the standard for Medicare coverage.

Do I need a new prescription every time I need a new monitor?

Yes. If your original monitor breaks or stops working, your doctor must write a new prescription for a replacement. Medicare will not cover a second monitor straightforward because you want a backup or because technology has improved.

Can I get a blood pressure monitor through a Medicare Advantage plan instead of Original Medicare?

Medicare Advantage plans must cover at least what Original Medicare covers, but some plans cover additional items. Contact your plan directly to ask whether they cover home blood pressure monitors and what the process is to obtain one.