Does Medicare Cover Heart Disease Treatment?
Medicare helps cover many of the costs associated with detecting, diagnosing and treating heart disease. This includes coverage for cardiovascular disease screenings and behavioral therapy to reduce your risk, as well as help with payments for certain heart disease treatments.
Does Medicare Cover Heart Disease Treatment and Prevention?
Original Medicare — Medicare Part A and Part B — helps cover the costs of preventing, detecting and treating heart disease and other types of cardiovascular disease (CVD).
When doctors use the term “heart disease,” they are generally referring to coronary heart disease, but most people use the term as a catch-all phrase for other types of CVD including coronary heart disease, stroke, heart defects from birth and peripheral artery disease.
- Heart and cardiovascular disease screening
- Behavioral therapy
- Cardiac rehabilitation (an exercise program for those with heart disease)
- Certain medications
- Diagnostic tests
- Doctor visits
- Open-heart surgery
Original Medicare covers the full cost of CVD screenings and Medicare-approved cardiovascular behavioral therapy. If you receive these services from a health care provider that accepts Medicare and charges the Medicare-approved costs, you will not owe anything out of pocket.
For other diagnostic tests, medications and heart disease treatments, you can expect to have out-of-pocket expenses.
What Each Part of Medicare Covers
Each part of Medicare covers different costs associated with heart disease and other cardiovascular diseases.
- Medicare Part A hospital insurance
- Medicare Part A covers hospitalization costs for up to 60 days once your deductible is met. You are responsible for your deductible plus any coinsurance costs if you are hospitalized beyond 60 days. Services covered include a semi-private room, meals and medications you take in the hospital.
- Medicare Part B medical insurance
- Medicare Part B covers 80 percent of the costs of non-hospital medical services, tests and items. You are usually responsible for 20 percent of the costs after you meet your deductible. Coverage includes the following:
- Visits to your primary care doctor
- Visits to your cardiologist
- Cardiac rehabilitation programs
- Diagnostic tests such as stress tests, MRIs, CT scans or electrocardiograms (EKGs)
- Heart disease screenings
- Medicare Advantage plans (Medicare Part C)
- Medicare Advantage plans are sold by private insurers that contract with Medicare. The plans are required by law to cover everything covered under Original Medicare — Medicare Part A and Part B. Medicare Advantage plans may also cover a portion of your costs for medicines used to treat heart disease and other types of CVD. Your out-of-pocket costs will vary depending on your exact plan and where you live. You may also pay more if you use doctors, hospitals and other providers who are not in your Medicare Advantage plan network. You should contact your plan administrator to find out exactly what your coverage includes.
- Medicare Part D prescription drug plans
- Medicare Part D drug plans are sold by private insurers. These plans can help you pay for medications needed to treat heart disease or other types of CVD. You will need to check your plan’s formulary, the list of all prescription drugs covered by the plan, to find out if the medicines you are prescribed are included.
- Medigap (Medicare Supplement) plans
- Medigap plans are supplemental insurance policies sold by private companies. Depending on the policy, the plans may pay a portion of your out-of-pocket costs under Medicare Part A and Part B.
Heart Disease Tests and Therapies That Medicare Covers
Original Medicare covers the full cost of two types of cardiovascular disease screenings. It also fully covers the cost of behavioral therapy that can help prevent heart disease or other types of CVD.
One type of screening covered by Original Medicare is a cardiovascular disease blood test that checks for conditions that could cause a heart attack or stroke. Medicare also covers an ultrasound test for those at risk of an abdominal aortic aneurysm, a condition in which the main artery carrying blood to your legs balloons out.
- Cardiovascular disease screenings
- Medicare Part B medical insurance covers the full cost of a CVD blood test once every five years. The test measures the following levels:
- Cholesterol — a waxy substance found in cells that is needed to make vitamin D, hormones and other substances that help you digest food
- Lipids — fatty acids that include natural oils, waxes and steroids
- Triglycerides — a type of fat your body stores for later use
- Abdominal aortic aneurysm screenings
- Medicare Part B covers a one-time ultrasound screening if you are at risk for an abdominal aortic aneurysm. You must meet the following conditions in order to be eligible for the screening:
- You have a family history of abdominal aortic aneurysms
- You are a man who is 65 to 75 years old and have smoked at least 100 cigarettes in your lifetime
Medicare will cover the cost of an abdominal aortic aneurysm screening only if your doctor refers you for the screening after determining you are at risk.
Medicare Coverage of Cardiovascular Behavioral Therapy
Medicare pays for a cardiovascular behavioral therapy session once each year. This session is usually done during a visit with your primary care doctor or another qualified health care professional.
The purpose of the visit is to learn about behaviors that increase your risk for heart disease or other types of CVD and to attempt to change those behaviors to reduce your risk.
- Checking your blood pressure
- Discussing the use of aspirin to reduce your risk (if appropriate for your condition)
- Counseling you on improved diet and nutrition to lower your risk
You will have no out-of-pocket expenses for these sessions as long as your doctor or health care provider accepts the Medicare-approved prices for these services.
6 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2021, February 8). Give Your Heart Some Love: Prevent Heart Disease. Retrieved from https://www.medicare.gov/blog/prevent-heart-disease-valentines-day
- American Heart Association. (2018, May 18). Access to Care. Retrieved from https://www.heart.org/en/get-involved/advocate/federal-priorities/access-to-care
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Abdominal Aortic Aneurysm Screenings. Retrieved from https://www.medicare.gov/coverage/abdominal-aortic-aneurysm-screenings
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Cardiovascular Behavioral Therapy. Retrieved from https://www.medicare.gov/coverage/cardiovascular-behavioral-therapy
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Cardiovascular Disease Screenings. Retrieved from https://www.medicare.gov/coverage/cardiovascular-disease-screenings
- National Heart, Lung, and Blood Institute. (n.d.). Know the Differences: Cardiovascular Disease, Heart Disease, Coronary Heart Disease. Retrieved from https://www.nhlbi.nih.gov/sites/default/files/media/docs/Fact_Sheet_Know_Diff_Design.508_pdf.pdf