Will Medicare Cover My Heart Disease?
Heart disease is the number-one killer in America. One person dies every 36 seconds from heart disease in this country, and about 659,000 people in the U.S. die from heart disease yearly – a quarter of all deaths.1
Are you concerned about Medicare coverage for your heart disease? Would you like to use Medicare benefits to allay the related costs? Let’s look at how each part of Medicare addresses heart disease.
Original Medicare and Heart Disease Care
Part A (hospital care) is applicable to inpatient hospital stays and skilled nursing facilities. This is particularly pertinent to heart-disease sufferers as 7.2% of visits to emergency departments are due to coronary artery disease, ischemic heart disease or a history of myocardial infarction.2
If you need surgery for a heart condition, including a stroke, heart attack, or heart condition Medicare Part A will cover this, though you must meet a deductible ($1,556 in 2022). Your specific coverage depends on your plan as well as your individual condition, but should also include:
- Nursing care
- Operating-room services
- A semi-private hospital room
If you have specific questions about your individual situation, call the number on this page to speak with an Ensurem licensed agent.
Part B (medical care) covers consultations with doctors and other providers. This addresses outpatient treatments as well as preventative services, the latter of which are fully covered by Medicare.
Examples of covered outpatient treatments are:
- Cardiac catheterizations
Examples of preventative services include:
- Cholesterol screens
- Blood pressure screens
- Aneurysm screens
Note: Medicare will not cover carotid artery stenting without embolic protection, which reduces risk by preventing debris from being released into the bloodstream.
Part B also covers most of the cost of cardiac rehabilitation, which includes counseling, exercise,
and education, if you have had at least one of these:
- Coronary angioplasty
- Current stable angina
- A heart attack within the last 12 months
- Stable chronic heart failure
- Heart valve replacement or repair
- Coronary artery bypass
- Coronary stent placement
You’ll have to pay a portion of the fee for treatments and diagnostic procedures. You can reduce this cost with a Medigap plan, which bridges gaps in coverage left behind by Original Medicare.
Living with more than one chronic condition?
You may qualify for Chronic Care Management under Part B if you have heart disease, plus one or more other chronic conditions. Some of the most common include arthritis, diabetes and asthma.
Part B Chronic Care Management services include:
- Around-the-clock provider access
- At least 20 minutes of related services monthly
- An individually crafted care plan
- Regular check-ins with your doctor or provider
Providers who can bill for this include:
- Physician assistants
- Nurse specialists
- Nurse practitioners
Those who can NOT bill for Chronic Care Management include:
- Limited-license doctors
Medicare Advantage and Heart Disease Care
Also known as Part C, these Medicare-approved private insurer-provided plans cover everything from Parts A and B. However, Medicare Advantage differs from Original Medicare in terms of more extensive coverage. These plans typically provide more benefits, including:
- Prescription drugs
- Gym memberships
- Home meal delivery post-inpatient stay
- Transportation to appointments
Medicare Advantage Plans are not a “one-size-fits-all” type of health care plan. There are many variations,
designed with different goals in mind. Chronic Condition Special Needs Plans (C-SNPs) for example are a special type of Medicare Advantage Plan targeted for people with chronic or disabling health conditions, like heart disease.
These plans offer benefits and services not found in other types of Medicare Advantage Plans. One of the most notable benefits of a C-SNP is the use of care coordinators. These care coordinators help you stay on track with your care. For example, a care coordinator can help schedule appointments, get the right prescription drugs and monitor other health-related activities.
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If you opt for a Chronic Conditions Special Needs Plan, you will likely have to choose a primary care doctor and get specialist referrals, in addition to making sure that you are aware of out-of-network costs.
Prescription Coverage for Heart Disease through Part D
Since Original Medicare does not include prescription drug coverage, you’ll get through by adding on Part D.
These are privately sold plans whose formularies vary, so you’ll need to confirm that your individual medications are covered.
Medicare Part D covers the following for those with heart disease:
- Angiotensin converting enzyme inhibitors
- Angiotensin II receptor antagonists
- Beta blockers
- Aldosterone-inhibitor diuretics
- Other diuretics
If you have a specific question about heart disease drug coverage, get in touch with a licensed Ensurem agent at the number on this page.
Medicare Supplement Insurance and Heart Disease Care
Medicare Supplement Insurance, also known as Medigap, are privately offered plans that can help you afford copays, coinsurance, deductibles and other fees related to health care services to treat heart disease.
You can still get a Medigap policy if you have heart disease, but this is not guaranteed. If you enroll outside of your Medigap Open Enrollment Period, you could have to go through medical underwriting to be approved for coverage.
For example, if you have experienced atrial fibrillation (also known as a heart arrhythmia) you might have difficulty getting approved – not because of the condition itself, but rather due to the medications you might take and other conditions you might have as a result. Congestive heart failure may also pose a problem if you’ve had it within the last two years. In addition, cardiomyopathy could cause your Medigap application to be declined, but if you’ve overcome it two or more years ago, this should be less of a problem. Finally, an enlarged heart could pose a problem, but less for the condition itself than the underlying issues that cause it.
What are the Different Types of Heart Disease?
Some of the most common types of heart disease are:
- Heart arrhythmias
- Pericardial disease
- Heart failure
- Coronary artery disease
- Congenital heart disease
- Heart valve disease
Risk factors include:
- High blood pressure
- Unhealthy blood cholesterol levels
According to the Centers for Disease Control and Prevention, nearly half of all Americans have at least one in three major risk factors: high blood pressure, high cholesterol, and smoking.
Questions to Ask Our Medicare Experts
Are you ready to ask one of our experts for more guidance but don’t know what to say first? Here is a list of questions to help get you started. Choose one that best fits your needs.
- What are the cardiac rehabilitation programs covered under Medicare?
- How does Medicare Part B contribute towards the costs of my treatment?
- Are prescription drugs for heart disease covered by Medicare?
- To what extent does Medicare cover cardiac rehabilitation?
- What specific heart disease screenings does Medicare cover?
- Are blood tests related to heart disease covered under my Medicare plan?
- How does Medicare supplement insurance help with my heart disease treatment costs?
- Does Medicare cover prescription maintenance drugs for heart disease?
- Are my cardiologist visits covered by Medicare?
- How is coronary artery disease treatment covered under Medicare?
- What chronic care management services does Medicare provide for heart disease patients?
- Does Medicare cover cardiovascular disease screenings?
- Are risk factors for heart disease considered in my Medicare coverage?
- Is cardiovascular behavioral therapy part of my Medicare coverage?
- How much will my out-of-pocket costs be for heart disease treatment under Original Medicare?
- Does medicare cover heart stents?
- Are cardiovascular screening blood tests covered?
- How does a Medicare Advantage Plan benefit someone with heart disease?
- What is the Medicare approved amount for different heart disease treatments?
- Does Medicare cover coronary angioplasty and coronary stents?
- Do I meet Medicare’s eligibility requirements for heart disease-related coverage?
- Are outpatient procedures for heart disease covered by Medicare?
- Does Medicare Part D cover my prescription drugs?
- Can I avail cardiac rehab under Medicare Part B?
- Are preventative services like cardiac catheterization covered by Medicare?
- Will Medicare cover outpatient services?
- Does Medicare cover the costs if I have a myocardial infarction?
Medicare Covers Many Aspects of Cardiovascular Disease
Finding a health care plan that helps manage your condition and doesn’t break the bank doesn’t have to be hard. But it is a big decision that requires a lot of research. If you’re living with heart disease the last thing you need is more stress.
If you’re struggling to determine what type of Medicare coverage will work for you, speak with an expert.
We have licensed insurance agents ready to help you through each step of the process.
They’ll complete a free, no-obligation consultation to help you find Medicare solutions that match your lifestyle taking the stress off of you.
Ensurem Trusted Expertise
Education is crucial in finding the right Medicare solution for you. With so many Medicare resources out there, it can be difficult finding a source you can trust. That’s why Ensurem has a Compliance Program dedicated to ensuring our Medicare content meets Centers for Medicare & Medicaid Services (CMS) regulations. So, you can rest assured you’re getting the information you need to make the right coverage decisions.
Denise Austin, 65, Ensurem Ambassador
Best-Selling Author, Creator of Fit Over 50 Magazine
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