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Medicare Coverage for Cardiovascular Disease


Medicare covers both inpatient and outpatient services for those with cardiovascular disease. Medicare coverage to prevent and treat cardiovascular disease is also available. Some screenings are under Part B. Part A covers hospitalization for a heart attack, stroke, heart surgery as well as rehabilitation. Your exact coverage will depend on your condition and the type of plan you have.

Does Medicare Cover Cardiovascular Disease?

Many people wind up staying in a hospital due to their cardiovascular disease. Whether you suffer a heart attack or need surgery, you could need inpatient care. Part A covers hospitalization for a heart condition, heart surgery, and stroke. Part A has a deductible and coinsurance costs that are your responsibility.

Coverage includes prescriptions, equipment, tests, therapies, nursing care, the operating room, and a semi-private hospital room. Also, you may be eligible for Chronic Care Management, talk to your doctor about your options.

Does Medicare Cover Outpatient Heart Procedures?

Part B can cover both preventative services and outpatient treatments you might need. Medicare will cover preventive services at 100%. Increasingly, routine heart procedures like angioplasties and stents are becoming outpatient procedures.

Preventative services may include:

  • Aneurysm Screens
  • Cholesterol Screens
  • Blood Pressure Screens

Outpatient services may include:

While preventive services have total coverage, diagnostic procedures, and treatments require you to pay a portion of the bill. A Medigap plan can reduce the amount you must pay for procedures.

Does Medicare Cover Heart Stents?

Carotid artery stenting is not covered by Medicare without emblic protection. Further, Medicare will only cover carotid artery stenting in facilities that meet CMS’s minimum standards. Also, Coverage is only available when using FDA-approved carotid artery stents and FDA-approved emblic protection devices.

Does Medicare Advantage Cover Cardiovascular Disease?

Advantage plans must cover at least as good as Medicare. Yet, restrictions like doctor networks come along with this plan type. But, many Advantage plans include extra benefits. For example, an Advantage plan could consist of a gym membership.

These plans must cover Cardiovascular screenings 100%, the same as Medicare. But, you’ll have a bill for diagnostic care and treatments.

Each company and plan is different depending on your location. Plus, the plans change each year during the Annual Enrollment Period.

But, if you don’t qualify or the cost is too high, there may be a Medicare Advantage Special Needs Plan for Chronic Heart Conditions. Some locations don’t have this option, but if your area does, it’s worth considering.

What are the Costs with Cardiovascular Disease if I have a Medicare Advantage Plan?

Let’s say you have an Advantage Plan with a $35 monthly premium and a $6,000 Maximum Out of Pocket. You may think, “wow, an affordable premium.” But, when you get the emergency medical bills, you’re going to say “wow” and not in a pleasant way. First, if you take an ambulance, it’ll cost YOU between $150-$300 or more in copayments. Then, the hospital costs are usually about $300-$600 each day for five to eight days.

Once you spend $6,000 on medical services, the plan approves, then they’ll cover your medical bills in full. But, that’s quite a bit, and the Maximum Out of Pocket resets every year on January 1st.

Considering a Medigap plan on average costs about $150-$200 a month, that’s way more affordable than $6,000 for the year.

Now, if you don’t qualify for Medigap, an Advantage plan can offer more protection than Medicare.

Do Medicare Supplements Cover Cardiovascular Disease?

Yes, Medicare Supplement plans can reduce your costs. Doctors’ appointments, hospital stays, surgeries, and medications are costly, even after Medicare pays their portion. A Medigap plan will cover all your out of pocket costs on anything Medicare covers.

What are the Costs with Cardiovascular Disease if I have a Medicare Supplement Plan?

So, let’s say you have Medigap Plan G, which is super easy to understand. With this plan, you’ll pay the premium and the Part B deductible. An ambulance falls under Part B benefits, so if you didn’t meet the deductible, you’d pay it here. Then, when you go to the hospital, the plan will pay all your coinsurances and Part A deductible.

The difference between Medigap and Medicare Advantage is significant savings. As long as you keep paying your monthly premium, you can count on Medigap to be there for you when you need it.

Does Medicare Cover Prescription Drugs for Cardiovascular Disease?

Most people with Cardiovascular disease need medications. Part A and B don’t cover prescription maintenance drugs, but Part D will. You can opt into buying a stand-alone drug plan or even get a Medicare Advantage Part D policy.

What cardiac medications does Medicare cover?

  • Anticoagulants
  • ACE Inhibitors
  • Beta-Blockers
  • Cholesterol-Lowering Medications
  • Diuretics

Monthly premiums generally depend on where you live. But most stand-alone drug plans cost around $30 a month.

Further, the average monthly price of cardiovascular medications is about $100 a month. But, Part D can help you lower medication costs.

Does Medicare Cover Heart Monitoring and Testing?

Medicare will cover critical testing. Part B will cover a Cardiovascular blood screen test every five years. The blood screen will include cholesterol, lipids, and triglyceride levels.

If your doctor accepts Medicare, you won’t pay for this screen. Sometimes, your doctor wants more screens than Medicare will cover. When Medicare doesn’t cover a test, you’ll pay the bill.

Does Medicare Cover Cholesterol tests?

Part B will cover blood tests for heart disease once every five years. The blood test will look at your cholesterol, triglyceride, and lipid levels to detect conditions that could lead to heart disease. You won’t pay anything for the test if the doctor accepts Medicare assignment.

FAQs

Does Medicare cover cardiovascular behavior therapy?
Yes, Medicare covers a yearly cardiovascular behavioral therapy visit.
Does Medicare cover open heart surgery?
Yes, Medicare covers open heart surgery that is necessary.
Does Medicare cover cardiac rehabilitation?
Medicare covers cardiac rehab if your doctor finds it necessary.  Rehab services can help reduce risks and improve health. Part B covers two types of cardiac rehab – general and intensive. Also, Part B covers general rehab sessions for 1-2 hours per day.

You’ll have coverage for 36 sessions within a 36-week timeframe. If your doctor determines it’s necessary, you can get an extra 36 sessions. If you need intensive rehab, Medicare will cover 72 sessions. You can go to six one-hour therapy sessions a day. You must attend all your sessions within an 18-week timeframe.

Does Medicare pay for a lipid panel?
Every five years, Medicare covers cardiovascular screening through a lipid panel.
Does Medicare cover heart bypass surgery?
Medicare does cover heart bypass surgery. Also, you would have coverage for a triple bypass surgery since these are both life-saving procedures.
Does Medicare cover a stress test?
Yes, Medicare covers a cardiac stress test and cardiac catheterization for people with heart disease. Also, coverage is available for stress tests when a doctor believes a patient has heart disease.
Does Medicare cover a nuclear stress test?
If a doctor orders a nuclear stress test to diagnose you or rule out an illness, Medicare will cover the test.

Get Started with Your Cardiovascular Disease Coverage Today!

Healthcare is costly, especially if you don’t have proper insurance. Don’t wait for a catastrophic event, if you become chronically ill, you might not be able to get a Medigap plan. Outside of the Medigap Open Enrollment Period, you’ll buy a plan with your health; if unhealthy, they can raise the premium or deny you.

Let our team find the best Medigap policy for you. We can provide you with several quotes. And, we can identify the company most likely to approve your applications, even if you have a pre-existing condition!

Give us a call at the number above or fill out an online rate form to see what the rates look like in your area!

Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

2 thoughts on “Medicare Coverage for Cardiovascular Disease

  1. Lindsey – help. Wife – now 80 – had aortic valve replacement – bovine valve some 6 years ago. We continue with an excellent cardiologist. A cardiac catheterization was ordered and performed in late 2020. Outpatient. Our insurance Medicare w/United Health Care supplement. Have not seen the catheterization procedure mentioned in any Medicare or UHC monthly insurance reports to us. Today the Hospital sent us a bill for $660.00 – not a problem for us financially. But – bill labeled “All Accounts” Cost – $61,175.50 – WTF. That blows my mind. Insurance adjustment $57,873, insurance pmt. – $2,642.00 – balance $660.00. If this kind of juggling is going on nationwide, looks like a method of falling into a “Non-Profit” Hospital category.

    1. Hi Gordon! Yes, this unfortunately is normal to see. However, if you have a Medigap plan, you should not be responsible for the $660 balance. I would contact the billing department to figure out why your supplement plan did not cover the balance. Depending on the letter plan you enrolled in, you could have some cost-sharing, but that seems high.

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