Medicare covers screening and a prevention program for cardiovascular disease. In addition, it covers doctor visits, diagnostic tests, medications, and surgery for the condition.
Coverage also includes cardiac rehabilitation, a counseling and exercise program for people with heart disease. The screening and prevention programs are free of charge. Other medical services have out-of-pocket costs.
This article provides an overview of Medicare coverage of cardiovascular disease, as well as specifics about coverage of early detection services and cardiac rehab. Next, it examines the costs of each part of Medicare and lists the programs that assist with expenses. Lastly, it discusses cardiovascular disease, along with the risk factors and symptoms.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Each of the four Medicare parts offers coverage, although in different areas.
Original Medicare consists of Part A, hospitalization insurance, and Part B, medical insurance.
Part A covers:
- heart conditions that require surgery, such as coronary bypass
- heart procedures, such as cardiac catheterization
- cardiovascular illnesses that require a hospital stay
Part B covers:
- doctor visits
- diagnostic tools, such as scans, echocardiograms, and stress tests
- cardiac rehabilitation program
Medicare Advantage, Part C, is the alternative to original Medicare and therefore provides Parts A and B benefits for cardiovascular disease. Many Advantage plans offer prescription drug coverage, which would include medications for the heart. Some plans also have a program to help a person quit smoking.
Part D is prescription drug coverage, which someone with original Medicare may buy. Each Part D plan has a formulary that has commonly prescribed medications, including those for cardiovascular disease.
It is important to detect cardiovascular disease in the early stages, and Medicare covers several services.
Every 5 years, people can get a screening test for the blood levels of cholesterol, triglycerides, and lipids. This test detects conditions that may cause a stroke or heart attack. If a person goes to a provider who accepts Medicare, this test has zero cost.
Cardiovascular behavioral therapy
Once a year, individuals may have a cardiovascular behavioral therapy visit with their primary care doctor. This involves the following:
- blood pressure check
- evaluation for aspirin use
- healthy diet counseling for people with a higher risk of cardiovascular disease
As with the cardiovascular screening, the cost of this therapy is free if someone goes to a provider who accepts Medicare.
Abdominal aorta aneurysm screening
Medicare covers a one-time screening for an abdominal aorta aneurysm, which is a ballooning out of the main blood vessel that transports blood to the legs. A person is eligible for this coverage if they have risk factors of an aneurysm, such as a history of smoking or a family history of the condition.
The screening is free of charge if someone goes to a provider who accepts Medicare.
Cardiac rehabilitation is a program of rigorous exercise, counseling, and education. Typically, the setting of the program is either a doctor’s office or a hospital outpatient unit. Medicare Part B provides coverage if a person has had one of the following:
With the exception of screenings and the prevention program, which are free, medical services for cardiovascular disease have the below out-of-pocket costs.
Part A costs pertain to inpatient services. In 2021, they include:
- $1,484 deductible for each benefit period
- $0 coinsurance for days 1–60
- $371 coinsurance per day for days 61–90
- $742 coinsurance per day for each lifetime reserve day for days 91 and beyond
Part B costs pertain to outpatient services. In 2020, they include:
Parts C and C
Parts C and D costs include deductibles, copays, coinsurance, and monthly premiums. These costs vary widely with the Part C or D plan and the company that offers it.
Medicare offers the below options to help with out-of-pocket costs.
- Medigap is Medicare supplement insurance, which a person with original Medicare may buy. The plans pay 50–100% of parts A and B costs, including those for cardiovascular disease.
- Extra Help provides assistance in paying Part D costs someone with limited income and resources. It helps with about $5,000 of medication expenses per year.
- Medicaidis a state-federal program that helps people with a low income pay healthcare costs.
- Medicare savings programs help individuals with a low income pay certain costs.
Cardiovascular disease is a medical term referring to disease of the heart or blood vessels. It is the top cause of death in America, according to the
The most common type of cardiovascular disease is coronary artery disease, reports the CDC. In this condition, blood vessels that bring blood to the heart become narrowed or blocked due to the accumulation of fatty deposits called plaque.
A blocked artery cuts off blood flow, which causes serious effects. If an artery supplying the heart is blocked, it results in a heart attack; while if an artery supplying the brain is blocked, it results in a stroke.
Cardiovascular disease may also cause a heart arrhythmia, which is an abnormal heart rhythm, or heart failure, which is the inability of the heart to pump blood adequately.
Key risk factors of cardiovascular disease include:
- high blood pressure
- high cholesterol
Other risk factors involve:
- physical inactivity
- unhealthy diet
- excessive alcohol use
A person with heart disease may not show symptoms until the condition has progressed. Someone with an arrhythmia may experience palpitations of the heart.
People having a heart attack may have symptoms that include:
- chest pain
- shortness of breath
- extreme tiredness
Individuals with heart failure may have symptoms, such as:
- swelling of the feet and ankles
- shortness of breath
Both original Medicare and Medicare Advantage provide coverage of screenings, tests, procedures, and surgery for cardiovascular disease. If a person with original Medicare needs prescription drug coverage, they may receive it through a Part D plan.
Someone with an Advantage plan who needs prescription drug coverage is not eligible to buy a Part D plan. However, most Advantage plans offer this benefit.