Does Medicare cover open heart surgery?

Heart disease is a leading cause of death in the United States. And open heart surgery has become common because of it. There have also been many medical advances in the area. While the term “open heart surgery” is somewhat vague and describes a range of procedures, most of these procedures result from an urgent medical condition. Some of them also result in complications as well as long post-surgery care and follow-up costs. Open heart surgery in the US can cost as much as $500,000 depending on the type of procedure. Fortunately Medicare can assist you with some of these costs.

While most Medicare literature doesn’t specify open heart surgery as a covered procedure, the US government’s health care program “covers many medically necessary surgical procedures.” The phrase “medically necessary” is key. Medicare will generally provide assistance with a wide range of conditions and procedures if your doctor can make the case that they are medically necessary for your survival or continued health.

Open heart surgery typically falls under the “medically necessary” category because it’s doubtful that doctors would recommend a procedure that involves opening the heart and operating on its internal structures if it were not vital to the patient’s continued health.

How much will Medicare pay?

It is difficult to know exactly how much Medicare will pay for your open heart surgery. Procedures vary in cost and complexity relative to your individual needs. Original Medicare Part A usually covers hospital-related expenses, which you will surely incur for a complex inpatient procedure like open heart surgery. You should examine your Medicare statements or contact Medicare directly to see how much your Part A deductible is and how much, if any of it, you have already paid during the year that you will have open heart surgery. Once you pay the full deductible, Medicare will begin covering the rest of your expenses.

Original Medicare Part B is typically used to cover your doctor’s services as well as extended recovery care and rehabilitation following open heart surgery. As with Part A, you will first need to pay your full Part B deductible. After you have done so, Medicare will pay 80% of the Medicare-approved cost for your procedure. You will be responsible for paying the other 20%. You may also be responsible for co-payments, depending upon how your surgery and aftercare is structured as well as how Medicare pays your individual benefits.

In addition to Original Medicare Parts A and B, you may receive open heart surgery cost assistance from Medicare Part C (also called Medicare Advantage) if you are a plan member. Medicare Supplemental Insurance (also called Medigap) is another option to explore. In all of these cases, you should consult with your doctor or healthcare provider to determine exactly what services you need, exactly how much they cost, and exactly how much Medicare or Medigap will assist you.

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