Often, seniors find that they may need screenings for heart disease. They may even need to find insurance coverage that will cover their pre-existing heart conditions. Medicare offers in-depth health care coverage for preventive care and treatments for those who suffer from various heart conditions. We’ll examine how Medicare covers these services and treatments and what you can expect on your road to recovery and rehabilitation.

Medicare Coverage for Heart Disease

Many people may have heart disease before they are eligible for Medicare coverage. And, of course, a top question is whether you can still receive Medicare coverage with a pre-existing healthcare condition like heart disease. Fortunately, you’ll never have to worry about enrolling into Medicare coverage with a pre-existing health condition unless you have End-Stage Renal Disease (ESRD).

Medicare won’t turn you away because of a pre-existing condition. Medicare can even cover cardiac rehabilitation programs for new beneficiaries who have had a heart transplant or bypass surgery within the past year.

Will Medicare Cover Heart Disease?

Heart disease is the leading cause of death among women and men in America today. The term heart disease refers to a variety of heart conditions, including:

  • Chronic Heart failure
  • Angina
  • Heart Arrhythmias
  • Heart attacks
  • Coronary Artery Disease
  • Hypertension (High Blood Pressure)

How Medicare Coverage for Heart Disease Works

Much like other heart conditions, Medicare coverage for heart disease works similarly. Your Medicare Part B coverage kicks in for all medical procedures in an outpatient setting. In addition to physician visits and services through your doctor’s office, Part B will also cover cardiovascular screening blood tests every five years.

If your heart disease lands you in a hospital, your Part A insurance will pick up your incurred medical costs. Remember that Part A coverage works as follows:

  • Your annual deductible for Part A is $1,632.
  • Days 1 – 60: Medicare will pick up the entire cost of inpatient care for 60 days.
  • Days 61 – 90: Your copayment is [GCBB#part-a-inpatient-coinsurance-days-61-90] for every day in the hospital during this timeframe.
  • Days 90 – 110: Your copayment is [GCBB#part-a-inpatient-coinsurance-days-91-120] daily in the hospital in . If you decide not to use them, you can pay the entire expense of the days in the hospital.

Medicare helps to cover screenings, procedures, and even rehabilitation for those who need it. Parts A and B work to cover inpatient and outpatient care expenses.

Medicare and Heart Surgery

Medicare helps cover a variety of heart surgeries and procedures. Should you require heart surgery, Original Medicare will cover your surgery. Medicare Part A will help cover surgical labs, exams, and services.

Medicare Part B covers your appointments with your doctor and additional outpatient services. You must first pay your annual deductible to receive coverage through Part B. At that point, Medicare Part B covers 80 percent of the services, and you’ll be responsible for the remaining 20 percent. Part D will help cover medications necessary that Part B won’t cover. In addition to surgical and physician expenses, you may be responsible for costs incurred at the facility where you receive your surgery.

Supplemental Medicare Plans and Hearth Surgery

If you’re enrolled in a Medicare Advantage plan, you should review the terms and conditions of your plan. These all-in-one programs must cover as good as Original Medicare or better but will have their own out-of-pocket costs. Most Medicare Advantage plans will have a fixed copay for heart surgery. These plans will also help cover the costs of prescription drugs.

Medicare Supplemental health insurance or Medigap plans cover some or all the out-of-pocket costs left over from Medicare. When enrolled in a Medicare Supplement plan, you can expect to pay little or nothing after Original Medicare pays its portions.

Does Medicare Cover Cardiologists?

Medicare will cover your visits to the cardiologist’s office. Part B coverage takes care of outpatient appointments. Once you reach the annual deductible, Medicare covers 80 percent of your cardiologist expenses, leaving you responsible for the remaining 20 percent of the bill. Of course, not all doctor’s appointments are the same, so the actual amount you’ll owe will depend on the services you receive. It’s essential to make sure that your cardiologist accepts Medicare. Otherwise, you may have hefty out-of-pocket expenses.

How Much Will Medicare Cover for Pacemaker Insertion?

Pacemakers are small devices surgeons insert into your chest to regulate your heartbeat. There are several different types of pacemakers, depending on your specific needs. Your out-of-pocket costs will vary depending on what kind of pacemaker you require. In addition to the out-of-pocket expenses you may need to pay towards your provider and your procedure, you may have additional charges to the surgery center where you receive your pacemaker procedure.

Does Medicare Cover A Heart Transplant?

If you need a heart transplant, Medicare will help cover your procedure. Medicare Part A (hospital coverage) covers labs, exams, and tests associated with your transplant surgery. Part A also helps cover follow-up care following your surgery and transplant medications (also known as immunosuppressive drugs). Part A also covers the procurement of the organs.

Medicare Part B (medical coverage) will cover all provider services associated with the heart transplant, like doctor visits. Part B also covers transplant medications that Medicare Part A won’t cover. Remember that for Part B to cover their portion, you must first meet your annual deductible. At that point, Part B will pay 80 percent of the expenses while you pay the remaining 20 percent. Transplant facilities typically charge separately, so you’ll want to call the facility first to confirm their charges for your procedure.

How Long Do I Need To Be on Medicare To Qualify For Heart Coverage?

To receive heart coverage for any condition you may have, you’ll have to have a doctor’s referral. Once your doctor determines that you meet all eligibility criteria, Medicare will cover rehab for those who have undergone valve replacements, bypass procedures, or heart transplants in the past 12 months. If you’re new to Medicare and your physician thinks it’s necessary to receive heart coverage, Medicare will cover you immediately.

Again, like with all procedures listed above, you must meet your annual deductible for Part B coverage. Once you reach the Part B deductible, Medicare pays 80 percent of the expenses you incur with doctor’s appointments, and you’ll pay the remaining 20 percent. Your Part A coverage kicks in if you require inpatient care within a hospital for a heart condition.

Are There Multiple Types of Heart Surgery?

Heart surgeries can come in a variety of shapes and sizes. Let’s look at some of the most prevalent heart surgeries among seniors in the United States.

CABG (Coronary Artery Bypass Grafting) is the most popular form of heart courtesy. The surgical procedure is often referred to as bypass surgery. The surgery involves a surgeon connecting one of your healthy veins or arteries from a different location within your body to your blocked coronary artery. The purpose of the surgical procedure is to help supply blood to the blocked artery.

Repair of an Aneurysm: The surgeon will replace or repair the weak part of your heart wall or artery.

Heart Transplant: Your unhealthy heart is replaced with a heart from a donor who has passed away.

Replacement or Repair of Heart Valve: This procedure involves a surgeon repairing or replacing your heart valve with an artificial one. Valves are either from a human heart, cow, or pig tissue.

Pacemaker Insertion: When an individual has a heart arrhythmia, the surgeon may insert a pacemaker. The pacemaker is a device that helps regulate your irregular heart rhythm.

VAD (Insertion of Ventricular Assist Device): Your surgeon inserts a pump to help your blood flow and heart’s functionality

Maze Procedure: This popular surgery blocks signals that cause AFIB (atrial fibrillation) in patients. Electrical signals are channeled in a different direction toward your heart chambers. Hence the term, Maze.


Will Medicare Cover Pacemakers?

Medicare will cover the insertion of a pacemaker. To qualify for coverage, your physician must deem the pacemaker medically necessary.

Will Medicare Cover Prescription Medications for Heart Disease?

As with most prescription medications, Original Medicare won’t cover most medicines for heart disease unless it’s for a heart transplant in most cases. Medicare Part D can cover many medications, including drugs needed after surgery. Your cost for your Part D policy and medications depends on the plan and carrier you choose to go with.

Do Medicare Supplement Plans Cover Heart Disease?

Medicare Supplement policies (also known as Medigap) will cover heart disease. These policies help alleviate the extra costs you incur with an illness or disease, such as cardiovascular disease. Medigap covers everything Original Medicare covers, in addition to your portion of out-of-pocket expenses.

Does Medicare Cover Cardiovascular Behavioral Therapy?

Medicare Part B covers one therapy session with your physician. At this visit, your doctor will typically check your blood pressure, among other tests. This appointment is fully covered as long as your doctor is contracted with Medicare.

Call Us Today To Get The Best Coverage Available!

Cardiovascular disease can be overwhelming, both physically and financially. Medigap plans are an excellent way to maximize your health coverage in an emergency. Our dedicated team can help get you the best coverage available. Let us find the best rate with the most comprehensive coverage today! Call our team at the number above, or complete an online rate form!

Related Content

Written By:
Picture of the author
Lindsay Malzone, Lindsay Malzone is the Medicare editor for Medigap.com. She's been contributing to many well-known publications since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.
Reviewed By:
Picture of the expert
Rodolfo Marrero, Rodolfo Marrero is one of the co-founders at Medigap.com. He has been helping consumers find the right coverage since the site was founded in 2013. Rodolfo is a licensed insurance agent that works hand-in-hand with the team to ensure the accuracy of the content.