Does Medicaid Cover Blood Pressure Monitors?

Does Medicaid Cover Blood Pressure Monitors

According to recent CDC data, hypertension (high blood pressure) was a primary or contributing cause of about 664,470 deaths in the United States in 2023. These people are at risk of suffering a stroke or even a heart attack. However, reports show that nearly half of U.S. adults (48.1%, about 119.9 million people) have hypertension. Measuring your blood pressure regularly is essential to maintain normal blood pressure.

According to the American Heart Association, home blood pressure monitors are essential for people with hypertension. However, blood pressure monitors are usually expensive. In such situations, one wonders if Medicaid covers blood pressure monitors. This article answers this query in detail.

Medicaid and Cost of Blood Pressure Monitors

Medicaid coverage for blood pressure monitors, as durable medical equipment, is subject to state-specific policies and may require a doctor’s prescription indicating medical necessity for managing hypertension. In addition, Medicaid coverage for ambulatory or wearable blood pressure monitors varies by state and is not widely implemented, with coverage typically limited to specific medical situations.

Blood pressure monitors are classified as “durable medical equipment” and come in a variety of designs. Medicaid covers specific medical devices, and this policy varies from state to state. In some states, Medicaid insurance policy specifically covers blood pressure monitors.

In others, Medicaid only covers certain types of blood pressure monitors. Still, there are some states without specific regulations regarding blood pressure monitors.

The best way to know is to contact your state’s Medicaid office or consult with your healthcare provider.

Cost of Blood Pressure Monitors Without Medicaid

The exact cost of blood pressure monitors depends on the type of device and the place you buy it. According to consumer reports, personal blood pressure monitors range between $30 to $120 and over.

Getting an automatic monitor that does not require a stethoscope is more efficient. These are the easiest to operate and maintain at home and also provide accurate readings. Make sure to buy blood pressure monitoring devices that are FDA-approved and medically validated for the best results.

How to Get a Medicaid-sponsored Blood Pressure Monitor

To have a blood pressure monitor covered by Medicaid, a prescription from a healthcare provider is typically required, demonstrating medical necessity, though policies may vary by state. Most states require prior authorization and a doctor’s prescription before Medicaid will cover a blood pressure monitor; you generally cannot directly purchase one with Medicaid benefits without approval.

There is a large variety of blood pressure monitors to choose from. For instance, you can choose between manual and automatic monitors. These are designed to indicate if your medication needs to be adjusted or if you need to make additional lifestyle changes. It is easy to share the readings of these advanced blood pressure monitors with your doctor.

According to the American Heart Association, the best blood pressure monitor is the automatic cuff-style monitor that is worn on the upper arm. You can buy this blood pressure monitor for a comfortable fit depending on the size of your arm.

How Much Money Does Medicaid Cover for Blood Pressure Monitors

Here are the different types of blood pressure monitors that are usually covered under a Medicaid insurance program:

1 – Blood Pressure Cuffs – BP cuffs fit on your upper arms, and air fills the band. Once the air is released, the blood flow resumes in your brachial artery in clearly detectable pulsing waves. Medicaid coverage for blood pressure monitors, including the percentage of cost covered, varies by state, and beneficiaries may be responsible for a portion of the cost depending on their specific plan and state regulations.

2 – Ambulatory Blood Pressure Monitors (ABPM) – These devices take blood pressure readings at regular intervals over 24–48 hours and record the results. Medicaid typically covers ABPM only in limited cases (for example, one 24-hour monitor per year for patients with suspected white coat or masked hypertension, similar to Medicare guidelines), and coverage varies by state.

Conclusion

Medicaid may cover the cost of certain home blood pressure monitors in many states (though not all states), depending on state-specific policies and medical necessity. Some states allow Medicaid beneficiaries to bear the partial expense of renting or buying a blood pressure monitoring device. It is strongly advised to talk with your physician or insurance provider to know the specific regulations in your state regarding Medicaid coverage for blood pressure monitors.

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