Understanding Medicare Coverage for Heart Disease

What Medicare does and doesn’t cover for heart disease and cardiovascular health

Because heart disease is the leading cause of death in the U.S., preventive cardiovascular care is essential for older adults. Medigap.com explains what Medicare does and doesn’t cover for heart disease and cardiovascular health.

 

1 in every 4 deaths in the United States are related to heart disease – the top cause of death in America for both men and women.

Adults aged 65 and older are more likely than younger people to suffer from cardiovascular disease, which is problems with the heart, blood vessels, or both.

That’s because aging can cause changes in the heart and blood vessels that may increase the risk of developing cardiovascular disease. 

As a result, heart health becomes increasingly important with age, meaning preventive care and routine screening should be a priority.

For Medicare beneficiaries, it’s important to understand which types of cardiovascular care, especially preventive care, are covered and what options are available if a procedure or special treatment is needed.

Find out what Medicare covers for heart disease, about Medicare-covered preventive care for cardiovascular health, about covered cardiovascular disease treatments, what Medicare doesn’t cover for cardiovascular disease and how to get coverage, and what to keep in mind when choosing a Medicare plan.

 

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Medicare coverage for heart disease

Depending on the severity of their heart condition, some people may need hospital inpatient care.

Medicare and most Medicare Advantage plans offer coverage for hospital services, outpatient care, and prescription drugs for enrollees with major conditions including heart attack and heart failure.

For example, Medicare Part A covers inpatient hospital stays for heart conditions, heart surgery, and strokes that have a deductible and out-of-pocket coinsurance fees. Coverage also includes prescriptions, tests, and therapies.

 

Medicare-covered preventive care for cardiovascular health

Typically, Medicare Part B covers 100% of preventive services and outpatient treatments. This includes doctor visits, screening tests, rehabilitation programs, and devices.

Cardiovascular disease screenings are covered every 5 years by Medicare Part B with deductibles and coinsurance waived. 

These screenings include blood tests for cholesterol, lipid, and triglyceride levels that help detect conditions that may lead to a heart attack or stroke.

Cardiovascular behavioral therapy can also help reduce the risk of cardiovascular disease. Done by a primary care doctor, this therapy may include checking blood pressure, discussing aspirin use, and learning about a healthy diet.

One cardiovascular behavioral therapy visit is covered every year by Medicare Part B, with no out-of-pocket costs because the therapy is classified as preventative services.

 

Which cardiovascular disease treatments does Medicare cover?

Cardiac rehabilitation
Cardiac rehabilitation is a customized outpatient program of exercise and education. 

It helps improve health and recover from heart attack, other forms of heart disease, or surgery to treat heart disease. 

If deemed necessary by your physician, Medicare covers cardiac rehab for 36 sessions within 36 weeks, and the potential for an additional 36 sessions for intensive rehab. 

Cardiac devices
Cardiac devices help people who have had a major cardiac event. These devices can include implantable cardiac defibrillators, pacemakers, and biventricular devices. 

Medicare will cover defibrillators if heart failure is diagnosed and Medicare Part A covers if the surgery happens in a hospital inpatient setting. 

Implantation of biventricular devices and pacemakers qualifies as an inpatient hospital service under Medicare Part A and as a prosthetic under Part B.

Medications
Medications are usually needed for most cardiovascular disease patients.

In most cases, Medicare Part D and Medicare Advantage will cover many drugs associated with controlling heart conditions and symptoms.

 

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What Medicare doesn’t cover for cardiovascular disease and how to get coverage

Some heart procedures may not be covered by Medicare unless you meet certain medical criteria and have a provider’s referral.

Medigap insurance
Medigap insurance is designed to cover the gap, or unpaid amount, in original Medicare coverage such as copayments, coinsurance, and deductibles.

Medigap will only cover bills that Medicare has approved and is designed to help you pay your share of the costs.

Medicare Advantage
Medicare Advantage (Part C) offers similar coverage to Medicare and provides Parts A and B benefits for cardiovascular disease. 

Many Advantage plans also offer prescription drug coverage, which would include medications for the heart.

Medicare coverage and insurance from Medicare Advantage plans focus heavily on heart disease prevention services, many of which do not require meeting a deductible or paying coinsurance.

 

What to keep in mind when choosing a Medicare plan

Deductibles, coinsurance, and copayments are all something to keep in mind while choosing a plan focused around heart health coverage. Out-of-pocket expenses can also vary depending on services and coverage. 

Part A costs include inpatient services like inpatient rehabilitation and skilled nursing facilities.

In 2022, they include:

  • $1,556 deductible for each benefit period
  • $0 coinsurance for first 60 days
  • $389 daily coinsurance for days 61–90
  • $778 daily coinsurance for each lifetime reserve day beyond 91 

Part B costs include outpatient services like home health services and durable medical equipment.

In 2022, they include:

  • $170 monthly premium
  • $233 annual deductible
  • 20% coinsurance

 

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Guest contributor: Lindsay Malzone is the Medicare expert for Medigap.com. She’s been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.

 

This article wasn’t sponsored and doesn’t contain affiliate links. For more information, see How We Make Money.


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