According to CDC.gov, “Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. One person dies every 36 seconds in the United States from cardiovascular disease. About 659,000 people in the United States die from heart disease each year…” What is the percentage of Medicare patients with coronary heart disease? According to cms.gov, 42% percent of Medicare beneficiaries age 65 years and over have at least one heart condition. With such a high percentage of Medicare beneficiaries requiring treatment for heart disease, it’s important to ask: does Medicare cover heart disease care?
Does Medicare Cover Heart Disease Care?
To start, it’s important to know that heart disease is a broad term that encompasses a range of conditions related to the heart, including coronary artery disease, heart failure, heart valve disorders, and heart arrhythmias.
Medicare offers coverage for a wide variety of services related to heart disease care, including heart disease screenings, rehabilitation, and behavioral training. Medicare covers different amounts for these services, depending on your specific health needs and the types of preventive services and treatments covered by your plan.
Medicare coverage for heart disease screenings
Medicare Part B (medical insurance) covers preventative cardiovascular screening blood tests for:
Medicare covers these tests once every five years. Doctors then use the results from these tests to identify risk factors or conditions that increase the patient’s risk of a stroke or a heart attack. As long as your doctor accepts Medicare assignment, there is no out-of-pocket cost for these screenings.
Medicare coverage for prescription drugs for heart disease
Medicare Part D (prescription drug insurance) covers prescription drugs for heart disease.
Heart disease is often managed or treated with prescription medications so it is very important for Medicare beneficiaries with heart disease to have a Part D drug plan or Medicare Advantage plan with prescription drug coverage. Co-pays and other out-of-pocket expenses may apply.
Both Part D plans and Medicare Advantage plans are available through private insurance providers.
Medicare coverage for cardiac rehabilitation programs
Medicare covers cardiac rehabilitation programs for qualifying conditions, including counseling, exercise, and education. Click here for a list of conditions that qualify Medicare beneficiaries for cardiac rehabilitation services.
Medicare Part B will also cover more intensive cardiac rehabilitation programs with a referral from your doctor.
Medicare Part A (hospital insurance) covers heart disease services received in a hospital setting. If you get heart disease services in a hospital setting, you will pay a copayment to the hospital for the Medicare-approved amount.
If you receive rehabilitation services in a doctor’s office, you would be responsible for paying co-insurance, which is 20 percent of the cost, after you have met your annual Medicare Part B deductible.
Medicare coverage for cardiovascular behavioral therapy
Each year, Medicare Part B will cover one cardiovascular behavioral therapy session with your primary care doctor or other qualified primary care physician for the purpose of helping beneficiaries lower their risk for cardiovascular disease. Behavioral therapy for cardiovascular health may include information about heart-healthy eating, discuss the benefits of aspirin (if appropriate), and check your blood pressure.
If your doctor accepts Medicare-assignment, there is no out-of-pocket cost for this therapy.
Medicare coverage for chronic care management services
If you have two or more chronic conditions such as hypertension and diabetes that are expected to last a year or longer, Medicare may cover chronic care management services. A comprehensive care plan will be put together by your physician and may cover services such as medication management, health goals, and 24/7 access to urgent care.
If you believe that you may qualify for chronic care management services, talk with your primary care physician to see if they provide this type of service.
Beneficiaries may pay a monthly fee for these services and the Part B deductible and coinsurance apply. Medicaid or supplemental insurance may cover the monthly fee.
Medicare doesn’t cover 100 percent of the costs for most medical treatments, including care for heart disease. It is always best to talk with your doctor about your medical needs and to confirm your expected out-of-pocket payments. Your plan provider or Medicare agent can both assist in assessing out-of-pocket costs and make recommendations for plans that will best suit your needs.
Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.
At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.