Does Medicare cover heart bypass surgery?

Coronary heart bypass surgery is among the most frequently performed surgeries in the United States. It is also among the most expensive. For the uninsured, heart bypass surgery can cost anywhere from $44,824 to $448,039 or more, depending on the facility and the number of blockages and complications a patient has. And according to an American Heart Association’s 2015 study, the average cost of a heart bypass surgery is $151,784. Considering several years of earnings can be eaten up during your 3-6 hours on the operating table, having insurance to offset the cost is essential. Medicare is one type of insurance that can help you.

Medicare’s Benefit Policy manual has no specific language detailing its coverage of heart bypass surgeries. Even so, Medicare routinely pays for heart surgeries like heart bypass, along with alternatives like angioplasties and coronary stents. This is because Original Medicare (Parts A and B) generally covers all medically necessary surgical procedures. Keeping your heart beating is universally accepted by Medicare as medically necessary! So as long as your procedure was performed by a certified cardiothoracic surgeon who agrees to be billed by Medicare, there’s little doubt at least some of your surgery’s cost will be shouldered by Medicare.

What is covered

With Medicare Part A, you will first need to pay your $1,288 deductible for your benefit period. You will also need to pay additional coinsurance if you’ve been an inpatient for more than 60 days in your current benefit period. After this is done, Medicare will begin to cover the costs you accrue as a hospital inpatient. For instance, Medicare will cover the following:

  • The preoperative diagnostic tests your doctor ordered to determine if you needed heart bypass surgery. These tests can include blood sample analysis, chest X-rays, electrocardiograms, and angiograms.
  • The operating room charges for your surgery.
  • Your stay in the intensive care unit (ICU) following your heart bypass. You will likely stay in the ICU for a few days after your surgery, followed by several more days in a standard hospital room before you are sent home.
  • A semi-private room.
  • Your nursing care.
  • The drugs and supplies given to you in the hospital.
  • Rehabilitation services you use, like physical therapy or cardiac rehabilitation programs.

As a recovering heart bypass patient, your doctor will likely recommend a few sessions of physical therapy to assist with recovery and teach you to move without damaging your incision. You can also take advantage of specialized cardiac rehabilitation programs covered by Medicare. As a heart bypass patient, you automatically qualify to receive them.

Your need for medical care doesn’t end when you leave the hospital, though. After getting heart bypass surgery, you will likely be prescribed drugs. These can include statins to lower cholesterol, blood thinners to prevent clots, beta-blockers to slow heart rate, ACE inhibitors to control blood pressure, and more. These medications can be expensive to get without insurance. But if you have Medicare Part D or a Medicare Advantage Plan that covers prescription drugs, these costs can be reduced through just paying premiums or small copays.

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