Medicare offers coverage for a wide variety of heart disease screenings, rehabilitation, and behavioral training. The amount that Medicare will cover depends on the type of preventive services and treatment covered by your plan, as well as your specific health needs.
Heart disease is a broad term that covers a range of conditions that can affect your heart, such as:
- coronary artery disease (CAD)
- heart arrhythmias (rhythm disorders)
- heart failure
- heart valve disorders
- heart wall muscle weakness (cardiomyopathy)
According to the Centers for Disease Control and Prevention (CDC), heart disease is a leading cause of death for both women and men in the United States.
Read on to learn more about what services related to heart disease Medicare does and doesn’t cover.
- cholesterol levels
- lipid levels
- triglyceride levels
If your doctor accepts the Medicare-approved rate payment in full, you won’t have to pay anything for these screenings.
You may also get a screening for aneurysm if you have a family history of aortic aneurysm, or if you’re a male between the ages of 65 and 75 and smoke or have a history of smoking.
Heart disease is often managed or treated with prescription medications. Original Medicare (parts A and B) doesn’t cover prescription maintenance drugs.
So, if you have an original Medicare plan and need prescription drug coverage, you can enroll in a Medicare Part D plan. Part D plans are available from Medicare-vetted private companies.
Another option is to enroll in a Medicare Advantage (Part C) plan. These plans are “all-in-one” replacements for original Medicare.
Most Medicare Advantage plans include prescription drug coverage. These plans are also available through private insurance providers.
Medicare covers cardiac rehabilitation programs for qualifying conditions. These programs include:
Qualifying conditions or treatments for rehabilitation program coverage (Part B) include:
- coronary artery bypass surgery
- coronary angioplasty (to open a blocked artery)
- coronary stent (to keep an artery open)
- heart valve repair or replacement
- heart attack (in the last 12 months)
- stable chronic heart failure
- heart or heart-lung transplant
- current stable angina (chest pain)
Medicare Part B also covers some intensive cardiac rehabilitation programs if you’ve been referred by your doctor. These programs typically include a more intense physical workout, as well as counseling and education.
If you get these services in a hospital setting, you’ll be responsible for paying the hospital a copayment of the Medicare-approved amount.
Each year, Medicare Part B will cover one cardiovascular behavioral therapy session with your doctor.
This therapy is designed to help you lower your risk for cardiovascular disease. It may include, among other things, a blood pressure check and information on heart-healthy eating.
If your doctor accepts the Medicare-approved amount, you won’t need to pay anything for this therapy.
Medicare may cover certain costs if you have two or more serious chronic conditions expected to last a year or longer. Some conditions that Medicare considers to be chronic include:
You may be covered for aspects of a comprehensive care plan that includes:
- health problems and goals
- healthcare providers
- medication management
- 24/7 access to urgent care
- available community services
Talk with your doctor to see if they provide this type of service.
You may pay a monthly fee for chronic care management services. Part B coinsurance and deductible apply. You may be able to cover the monthly fee through Medicaid or supplemental insurance, such as Medicare Part C.
Medicare will cover many diagnostics tests used to diagnose heart disease. Medicare also covers cardiac rehabilitation programs and cardiovascular behavioral therapy if you have a qualifying health condition.
If necessary, Medicare will cover chronic care management services as well.
Medicare doesn’t cover 100 percent of all costs. Talk with your doctor about your needs and expected out-of-pocket payments, including the cost of medications.
You may be able to reduce out-of-pocket costs with additional insurance, available from private companies. These include: