Heart disease affects
The cost of treatments, prescription drugs, screenings, and surgery can be quite significant, and Medicare can help offset some of those costs.
Below, we outline the factors to consider when selecting a Medicare plan if you have a heart condition.
What does it mean to be in network or out of network?
When a healthcare professional, hospital, or pharmacy is part of a Medicare plan, they are considered in network. If a plan doesn’t cover them, they’re considered out of network.
Before choosing or switching plans, it’s a good idea to check whether your preferred healthcare professionals, hospitals, and pharmacies are in network. Doing so can help you save money and avoid the inconvenience of shopping for new ones.
Screenings can help prevent serious health complications like strokes and heart attacks.
Original Medicare (Part B) covers heart disease screenings like blood tests for triglycerides, lipids, and cholesterol levels.
These screenings are covered once every 5 years. If you have high cholesterol, Medicare Plan B will also cover screenings to monitor your response to treatments.
People with risk factors for an abdominal aortic aneurysm also get a one-time screening.
Cardiovascular behavioral therapy aims to lower your heart and blood vessel disease risk. Medicare covers one therapy visit each year.
During therapy, your doctor may:
- take your blood pressure
- give you healthy eating tips
- review your medication and discuss aspirin if necessary
Cardiac rehabilitation programs are activities designed to improve your heart health and reduce your risk of heart condition complications such as a stroke or heart attack. Rehab programs may involve:
- psychosocial assessment
- individualized treatment plan
Original Medicare (Part B) covers general and intensive cardiac rehabilitation programs if your doctor refers you and you have any of the following conditions or procedures:
- heart attack in the past year
- coronary bypass surgery
- stable angina pectoris (chest pain or discomfort caused by heart disease)
- heart valve repair or replacement
- coronary angioplasty or stent (opening or widening of an artery)
- heart or combined heart-lung transplant
- stable chronic heart failure (Medicare only covers general cardiac rehabilitation for this condition)
Original Medicare (Part A) covers surgery, procedures, or hospital stays for heart conditions. If your inpatient stay is 60 days or less, you may not need to pay anything. To be covered by Medicare, your inpatient stay must be:
- in a hospital that accepts Medicare
- ordered by a doctor who states you need an inpatient stay to treat your condition
Medicare will cover:
- semi-private rooms
- general nursing
- drugs administered during your stay
- other services and supplies staff uses to treat you
Medicare will not cover:
- private nursing
- a private room (unless ordered by a doctor)
- a television or phone in your room
- personal supplies like slippers, toothbrushes, socks, slippers, and razors
Original Medicare doesn’t cover heart medication or any other drugs. If your heart condition requires medication, you’ll need Medicare Part D or a Medicare Advantage plan that also covers medication.
Smoking cessation is covered by original Medicare. Medicare Part B covers eight counseling sessions per year. If your professional accepts assignments, these sessions would be free.
Medicare may not cover additional sessions, medication, patches, or other interventions.
Some Medicare Advantage plans may also offer tailored smoking cessation programs.
Medicare Chronic Care Management (CCM) helps you receive care for chronic conditions. A Medicare-approved medical professional arranges and supervises this care. You can qualify for CCM if you have two or more chronic conditions that:
- are expected to last at least 1 year or are lifelong
- put you at risk of decline or death
Examples of such conditions include:
- heart disease
- high blood pressure
- mental health conditions
Medicare can help you pay for the care and treatments you need if you have a heart condition. You should confirm that your healthcare professionals are in network and accept assignments.
You can enroll for a new Medicare plan or switch plans during the Open Enrollment Period from October 15 to December 7. When your new plan’s coverage starts, the old plan’s coverage will end immediately.