Alongside Lp(a), blood pressure, and inflammation, ApoB is the best biomarker of heart disease risk. Cardiology Professor Sotirios Tsimikas ranks ApoB and Lp(a) as the top heart health biomarkers to test.
But ApoB is not widely covered by health insurance, including Medicare. This post will explain why ApoB isn’t currently covered by Medicare, some of the evidence, how to get an ApoB test affordably.
Medicare covers basic lipid panels, but not ApoB
Medicare’s coverage policy specifies that it covers basic lipid panels, and denies coverage for everything else:
Under preventative services, Medicare Part B covers the basic lipid panel (total cholesterol, high density lipoprotein-cholesterol (HDL-C), triglycerides, and low density lipoprotein-cholesterol (LDL-C) for cardiovascular (CV) disease screening, every 5 years when ordered by a doctor.
This policy denies coverage for all CV risk assessment panels, except the basic lipid panel,
In particular, Medicare specifically doesn’t cover Apolipoprotein B (Apo B), Lipoprotein(a), Apo A1, Vitamin D, or any other cardiovascular risk panels.
What evidence did Medicare review?
Medicare’s current coverage policy is largely based on a US Preventive Services Task Force (USPSTF) 2009 report. In this report, the USPSTF concluded that there wasn’t enough evidence to support using newer, “non-traditional” risk factors to screen people without symptoms or a history of coronary heart disease (CHD). These non-traditional tests include markers like hs-CRP, ABI, leukocyte count, fasting glucose, periodontal disease status, carotid thickness, coronary calcium scoring, homocysteine, and Lp(a). The USPSTF found that, except for hs-CRP and ABI, it was unclear how many people would be recategorized as higher risk by these tests, and even for those two, there wasn’t proof that changing treatment would help. They also warned that expanded testing could lead to unnecessary medication use or anxiety. Their guidance at the time: stick with established risk models like the Framingham score for guiding heart disease prevention in adults.
Since 2009, many new guidelines have come out from the American Heart Association, American College of Cardiology and others. The guidelines recommend testing for ApoB, Lp(a), and inflammation (hs-CRP) based on compelling evidence that these are more accurate than traditional markers like cholesterol.
How does ApoB relate to cholesterol?
Our guide to the science behind the ApoB test explains how ApoB and LDL relate. But as a quick summary, ApoB counts the number of atherogenic particles — including LDL cholesterol, VLDL cholesterol, and IDL cholsterol — whereas LDL measures the mass of cholesterol within only one of these. Since ApoB measures every atherogenic particle, it’s a more accurate test of heart disease risk.
How to get an ApoB test affordably
While Medicare doesn’t currently cover ApoB testing, you can buy it for under $200. Empirical Health’s comprehensive health panel includes ApoB, Lp(a), and hs-CRP among 100 total biomarkers.
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