Does Medicare cover heart disease? 5 major questions answered

Medicare covers various heart disease screenings, behavioral training, and rehabilitation. It is important to note that the amount of coverage Medicare offers depends on the amount of preventive treatment and services your plan covers. It also depends on your specific health-related needs. Cardiovascular or heart disease is a general term used to discuss many different conditions affecting the heart. These conditions include:

• Cardiomyopathy (heart wall muscle weakness)
• Coronary artery disease (CAD)
• Heart valve disorders
• Heart arrhythmias (rhythm disorders)
• Heart failure

A report released by the Centers for Disease Control and Prevention (CDC) shows that heart disease is one of the main causes of death among men and women in the U.S. Having said that, it is important to learn about which heart-disease-related services Medicare covers and which ones it does not.

Does Medicare cover cardiovascular screenings?

Original Medicare comprises hospital insurance (Part A) and medical insurance (Part B). Medical insurance offers coverage for cardiovascular screening blood tests for the following:

• Triglyceride levels
• Lipid levels
• Cholesterol levels

Medicare offers coverage for these blood tests once every half a decade. These tests produce results that help doctors identify conditions or risk factors that may result in a heart attack or stroke. It is worth noting that you will not part with any money if your doctor gives the green light for the rate payment in full. Besides, you may get an aneurysm screening if the following two conditions prove to be true:

• You are a male aged between 65 and 75 and have been smoking or have a smoking history
• You have a family history of aortic aneurysm

Does Medicare cover prescription drugs for heart disease?

Prescription medications are usually used to treat or manage heart disease. However, original Medicare does not offer coverage for prescription maintenance drugs. This means if you have original Medicare and are looking for coverage for heart disease prescription drugs, then you may have to enroll in Medicare Part D, which is offered by Medicare-vetted private companies.

Alternatively, you can enroll in Part C, which is also referred to as the Medicare Advantage plan. Part C is an “all-in-one” replacement plan for Original Medicare, and it includes coverage for prescription drugs. Like Part D, Medicare Advantage is issued by private insurance companies.

Does Medicare cover cardiac rehabilitation programs?

Cardiac rehabilitation programs are put into place after heart attack survival, and Medicare offers coverage for them in instances of qualifying conditions. These programs are education, counseling, and exercise. Qualifying conditions or rehabilitation program treatments that Part B covers include:

• Chest pain (current stable angina)
• Coronary artery bypass surgery
• Heart or heart-lung transplant
• Coronary angioplasty, which is performed to open an artery that is blocked
• Stable chronic heart failure
• Coronary stent, which is carried out to keep the artery open
• A heart attack that occurred in the last 12 months
• Heart valve replacement or repair

Furthermore, Part B offers coverage for some cardiac rehabilitation programs that are intensive in the event that your doctor refers you. These programs range from education and counseling to an intense physical workout. If you go for these services in the hospital, you will be required to pay the copayment of the amount approved by Medicare. But if these services are provided in a doctor’s office, you will be required to pay 20% of that amount. Ideally, you should note that you have to meet your Part B deductible, which is $226 as of 2023.

Does Medicare cover cardiovascular behavioral therapy?

Part B covers a single session of cardiovascular behavioral therapy each year. This therapy is often done with the help and guidance of your doctor, and it is aimed at lowering your risk of cardiovascular disease. It includes information on healthy eating habits to protect the heart as well as a blood pressure check, among others. You will not need to pay anything when going for this therapy in case your doctor accepts the amount approved by Medicare.

Does Medicare cover chronic care management services?

If you have at least two chronic conditions that your doctor expects to go for at least a year, you may rely on Medicare to cover certain costs. Medicare considers the following conditions to be chronic:

• Hypertension
• Diabetes
• Asthma
• Heart disease

The coverage may come with comprehensive care plan aspects, such as:

• Available community services
• 24/7 access to urgent care
• Medication management
• Health problems and goals
• Healthcare providers

It is recommended to engage the practitioner to see if they offer these kinds of services. You should also note that a monthly fee for chronic care management services may apply. Also, Part B deductible and coinsurance may apply. To cover these monthly fees, it is advisable that you enroll in Medicaid or supplemental insurance like Part C.

As seen above, Medicare offers coverage for multiple diagnostic tests that doctors rely on to diagnose heart disease. It also offers coverage for cardiovascular behavioral therapy and cardiac rehabilitation programs in case of a qualifying health condition. Moreover, Medicare offers coverage for chronic care management services if necessary.

Since Medicare does not cover 100% of all costs, it is imperative that you consult your doctor about your needs and what out-of-pocket payments you need to make. You may rely on additional insurance to minimize out-of-pocket expenses. These additional insurance plans are provided by insurance companies, and they include Part D, Part C, and Medigap.