Medicare coverage to prevent and treat cardiovascular disease is possible. Some screenings are under Part B. Part A covers hospitalization for a heart attack, stroke, heart surgery or other heart-related condition, as well as rehabilitation in a hospital or skilled nursing facility.
Your exact coverage will depend on your condition and the type of Medicare plans you have.
Medicare Hospitalization Coverage for Cardiovascular Disease
Part A covers hospitalization for a heart condition, heart surgery, stroke, or any other reason. Part A has a deductible ($1364 in 2019), and after that, you pay 20% of the remaining costs.
This includes prescriptions, equipment, tests, therapies, nursing care, the cost of the operating room, and a semi-private hospital room.
If you’re in the hospital for more than 60 days, you must pay a daily coinsurance for days 61-90. After the 90th day, you can use up to 60 additional “lifetime reserve days” to pay for hospitalization throughout your lifetime.
However, if your doctor prescribes additional care at a rehabilitation hospital after your hospital stay, you’ll have coverage. Rehabilitation hospitals have the same coverage as any other hospital stay.
Skilled nursing facilities are fully covered for 20 days, and from day 21-100 you must pay a daily copay. However, there is no coverage for skilled nursing care after the 100th day.
Medicare Coverage for Outpatient Heart Procedures
Increasingly, routine heart procedures like angioplasties and stents are performed on an outpatient basis. Although if you have an outpatient heart procedure, it is covered under Part B’s medical coverage.
Part B pays 80 percent of the cost of the procedure, and you are responsible for the other 20 percent if you don’t have any supplemental coverage.
However, Medigap policy can reduce or eliminate the amount you must pay out of pocket for outpatient procedures.
An Overview of Cardiovascular Disease
Cardiovascular disease, also known as heart disease, encompasses many ailments that impact the heart and circulatory system. Cardiovascular disease can be a sudden, life-altering event or a chronic condition.
Common types of cardiovascular disease include:
Heart attacks happen if a blood clot prevents blood from flowing to a part of the heart. If you have a heart attack, you may need coronary bypass surgery or angioplasty. Also, after a heart attack, you may need to take medication and make lifestyle changes.
Strokes happen because of problems with the blood vessels that supply the brain. Strokes can cause permanent loss of brain function and paralysis, or their effects can be temporary.
Heart failure does not literally mean the heart fails. It means that the heart isn’t pumping enough blood to meet the body’s need for blood and oxygen.
An arrhythmia is an abnormal heartbeat – either too fast, too slow, or irregular. An arrhythmia can prevent your heart from pumping enough blood to the rest of your body. Arrhythmia treatment can be done with medication and/or a pacemaker.
Stenosis is when the heart valve doesn’t open enough to let blood flow through. If you have stenosis, you may need medication or heart valve surgery.
Cardiovascular Behavior Therapy is Covered by Medicare
Medicare does cover one time yearly cardiovascular behavioral therapy visit. You’ll pay nothing for this visit as long as your doctor accepts Medicare assignment.
Medicare Coverage for Heart Monitoring and Testing
Part B will usually cover a blood test every five years to evaluate your cholesterol level, lipids, and triglycerides. It will also cover routine blood pressure tests.
Diabetes increases your risk of heart disease, and so Medicare may pay for diabetes screening tests if your doctor thinks you may be at risk. Those with a family history of aortic aneurysms, Medicare may pay for a free screening of abdominal aortic aneurysms.
If you already have heart disease or are showing symptoms of heart disease, Medicare will pay for a cardiac stress test ordered by your doctor to identify whether there are blockages to your heart.
Medicare will also pay for a follow-up procedure, a cardiac catheterization.
How Supplemental Medicare Coverage Can Help with Cardiovascular Disease
A heart condition can mean a sudden trip to the hospital, frequent follow-ups with doctors, and medications to manage blood pressure and other issues. While Original Medicare pays much of the cost, it does not cover everything.
If in the hospital, you must pay a Part A deductible, and if your hospitalization stretches beyond 60 days you will be responsible for a copayment of hundreds of dollars per day.
For outpatient services, doctor visits, pacemakers and other services covered by Part B, you must pay 20 percent of the cost. And Original Medicare doesn’t cover prescriptions at all.
Although, a Medicare Supplement plan can reduce or eliminate out of pocket costs for Part A and B services. A Part D prescription drug plan will greatly reduce the cost of heart medications, and in many cases, you pay a predictable copay for the medicines you take regularly.
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