Does Medicare Cover Heart Disease Care? Screenings, Hospital Stays, Meds—Explained
Expert advice on what’s typically free, what comes with deductibles and how to avoid overpaying
According to the World Health Organization,19.8 million people died from cardiovascular diseases in 2022. And seniors—many of whom are on Medicare—are one of the groups most affected by the condition. But what does Medicare cover when it comes to heart disease care? Read on for the answer.
A quick heart disease overview
Common heart issues include coronary artery disease, arrhythmias and heart failure—conditions that can cause symptoms like shortness of breath, fatigue, chest pain and heart palpitations. Heart disease is often diagnosed with electrocardiograms, echocardiograms or blood tests, but sometimes stress tests, CT scans, chest X-rays and other tests may be ordered as well.
What people on Medicare need to know about heart disease coverage
When it comes to getting care for heart disease while on Medicare, Whitney Stidom, vice president of consumer enablement at the online health insurance broker company eHealth, says understanding your health insurance coverage is key.
Woman's World Answers
“Heart disease is the leading cause of death in the U.S., and the risk of this condition increases with age. That’s why making strategic Medicare coverage choices is so important,” she explains. “Over 40 percent of Medicare beneficiaries have some form of heart disease, so it is crucial for people with this condition to carefully consider their Medicare coverage options, as doing so can help reduce out-of-pocket costs for specialist visits and prescription medications.”
Heart disease coverage options for people on Medicare
Traditional Medicare has four parts: Part A, Part B, Part C and Part D, and when it comes to heart disease coverage, some parts are more important than others, says Stidom.
“Medicare Part B covers cardiovascular disease screenings every five years. This includes tests for cholesterol, lipid and triglyceride levels to see if people are at risk of cardiovascular disease. These screenings are covered at no cost to beneficiaries when administered by a doctor accepting Medicare,” she says.
“Original Medicare Part A covers hospital care, while Part B covers doctor charges. However, there can be significant out-of-pocket costs with Original Medicare in the form of annual deductibles and coinsurance, which can add up quickly for someone needing care to manage a heart condition.”
How does Medicare cover prescription drugs used to treat heart disease?
Common heart disease medications include statins, beta-blockers and ACE inhibitors. There are also newer medications such as SGLT2 inhibitors and GLP-1 agonists, which can help fight heart failure and diabetes. These drugs are often covered by Medicare Part D, but even with that coverage Americans might still have to pay an out-of-pocket fee.
“Original Medicare Parts A and B don’t provide standard prescription drug benefits, though they may cover drugs administered in a hospital or clinic setting,” says Stidom. “For help paying the cost of prescription drugs, Medicare beneficiaries must enroll in either a standalone Part D prescription drug plan or in a Medicare Advantage plan. All Medicare Advantage drug plans and standalone Part D plans will provide coverage for prescription drugs, including statins and blood thinners. However, which specific drugs are covered and how much a beneficiary will pay out of pocket for them can vary from one Medicare Advantage plan to another.”
To avoid overpaying, she recommends comparing plans during the Medicare Advantage Open Enrollment Period, which runs from January 1 through March 31.
Are there any special Medicare programs available to people with heart disease?
Having heart disease can be expensive. One tool Stidom recommends for people with any of the conditions above is the Chronic Special Needs Plans (C-SNPs)– Medicare Advantage plans designed to help people with heart disease access quality affordable care.
“Compared to a traditional Medicare Advantage plan, someone with heart disease enrolled in a C-SNP may benefit from a lower out-of-pocket maximum,” she says. “Other resources that may be offered include a grocery allowance to support access to nutritious food; richer dental benefits to support the prevention and treatment of gum disease, which is linked to an increased risk of complications from heart disease; and access to lifestyle coaching programs to support improved exercise and eating habits.”
What’s more, if you’re diagnosed with heart disease and aren’t on Medicare, there is a Special Enrollment Period for people eligible for Medicare.
“If you or a loved one is diagnosed with heart disease, that provides an ideal opportunity to evaluate what Chronic Special Needs Plans may be available in your area and if they are a good match for your needs,” she explains. “A licensed health insurance agency can help Medicare beneficiaries compare plans based on individual needs and preferences, including assistance with selecting a Chronic Special Needs Plan.”
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