Both Original Medicare and Medicare Advantage cover a cholesterol screening test every 5 years. Coverage is 100%, which makes the test free of charge.

If a screening shows a condition that warrants investigation, further tests fall under the diagnostic rather than the screening category.

Original Medicare usually pays 80% of costs for covered diagnostic services. The amount of coverage under Medicare Advantage varies with the individual plan.

This article will discuss Medicare coverage of cholesterol tests. It will also examine who should get a cholesterol test, what it measures, and what to expect during the test.

We also look at lifestyle practices that may lower the risk of high cholesterol.

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

  • Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
  • Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
  • Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

a man having a cholesterol test that may he does have cover for on his medicare planShare on Pinterest
A person with Original Medicare is eligible for a cholesterol screening every 5 years.

The information below provides an overview of the cholesterol screening coverage of Original Medicare and Medicare Advantage.

Original Medicare

If a person has Medicare Part A and Part B, also known as Original Medicare, they can get a cholesterol screening every 5 years. The coverage is 100% as long as their doctor accepts Medicare. However, there may be a copayment for the doctor’s visit.

For some people, a doctor may recommend more frequent screenings. Also, the screening may indicate the need for further tests or treatment. In such instances, a person may have to pay all or part of the costs. If Part B covers the services, the copayment is 20%.

Some individuals may have a Medigap plan, which is Medicare supplement insurance. If so, it may cover all or part of the copayment. The amount a person owes will depend on their plan.

Medicare Advantage

A person with Medicare Advantage may also get the cholesterol screening every 5 years, at no cost. However, to get complete coverage, they must see an in-network doctor. As with Original Medicare, the person may have to pay a copayment for the doctor’s visit.

If someone needs further tests or treatment, then copayments and deductibles apply. The amounts vary, depending on the person’s Advantage plan.

Cholesterol is a waxy substance the body needs to digest fats and produce hormones. The body produces all the cholesterol it needs for these purposes. However, cholesterol also comes from certain foods, such as fatty meats.

When a person’s cholesterol level is too high, it causes plaque to build up in the arteries, which are the vessels carrying blood from the heart to every part of the body.

When an artery has a lot of plaque, it can block the blood flow. A blockage in an artery to the heart causes a heart attack, and a blockage in an artery to the brain causes a stroke.

According to the Centers for Disease Control and Prevention (CDC), nearly one-third of American adults have high cholesterol. The condition does not cause symptoms, hence why doctors advise screenings.

Guidelines from the CDC for cholesterol screening frequency are as follows:

  • once for children between the ages of 9 and 11 years
  • once for people between the ages of 17 and 21 years
  • every 4 to 6 years for all other adults

Doctors may recommend more frequent screenings for some people, including children with obesity or adults with any of the following risk factors:

A cholesterol test, or lipid profile, is more than a single reading. It includes four measurements.

Low-density lipoprotein cholesterol

Doctors call low-density lipoprotein (LDL) “bad cholesterol” because it is the primary source of blockages.

An optimal reading for LDL is less than 100 milligrams/deciliter (mg/dl). Borderline high is 130–159 mg/dl, and high is 160–189 mg/dl.

High-density lipoprotein cholesterol

Another name for high-density lipoprotein (HDL) is “good cholesterol” because it helps remove LDL.

A reading of at least 40 mg/dl is desirable, but doctors consider a reading of 60 mg/dl or higher to be protective against heart disease.

Total cholesterol

Total cholesterol is a combination of LDL and HDL. A desirable reading is less than 200 mg/dl. Borderline high is from 200–239 mg/dl, while high is 240 mg/dl and above.

Triglycerides

Triglycerides are a type of fat in the blood. A desirable reading is usually less than 150 mg/dl. High levels of triglycerides with low HDL or high LDL indicate a person is at risk of heart disease.

A person having a cholesterol test may not eat or drink anything except water for 9 to 12 hours beforehand.

Medical labs usually schedule the test in the morning hours.

The procedure takes approximately 5 minutes and involves inserting a needle into a person’s vein to collect blood in a test tube.

The individual may feel a small sting from the needle. Later, they may experience slight pain or bruising at the insertion site. Most symptoms disappear quickly.

People cannot change their family history or age, but lifestyle practices may reduce their risk of high cholesterol. These include:

  • Abstaining from smoking. This habit harms the blood vessels and raises the risk of a heart attack or stroke.
  • Getting regular exercise. Health authorities recommend 30 minutes of moderate exercise 5 days per week.
  • Maintaining a healthy weight. Being overweight increases the likelihood of high cholesterol and heart disease.
  • Eating a healthful diet. This practice involves eating foods rich in fiber, such as fruits and vegetables, as well as unsaturated fat, such as nuts and avocados. It also includes avoiding salty and sugary foods, and foods high in trans or saturated fat.

Whether a person has Original Medicare or Medicare Advantage, the plan will cover a cholesterol screening once every 5 years. The coverage includes 100% of the costs, except for a copayment for the doctor’s visit.

However, if someone needs more frequent screenings or more in-depth testing, they may have to pay all or part of the costs.

High cholesterol increases the risk of heart disease. People who wish to lower their risk can do so by engaging in healthy lifestyle practices, such as getting regular exercise and eating a nutritious diet.

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