Medicare Guide to Heart Disease


By Danielle Kunkle Roberts

The term “heart disease” encompasses a variety of conditions that can affect your heart, including coronary heart disease, muscle weakness in the wall of your heart and heart rhythm disorders.

Heart disease is a leading cause of death for both men and women in America. Many factors can contribute to heart disease including high blood pressure and cholesterol, tobacco usage, alcohol usage and being overweight.

If you or someone you love has heart disease, here are the things you’ll want to know about Medicare’s coverage in 2019.

Screenings for Heart Disease

Medicare Part B covers a variety of screenings that can help your specialist to spot heart disease. This includes a blood pressure screening in an annual physical with your physician.

Medicare also covers screenings for high cholesterol every five years. If you are diagnosed with heart disease or found to have high cholesterol, Medicare will also provide for the necessary lab tests to monitor your condition.

People with a family history of aortic aneurysm or men between 65 and 75 who smoke or have a history of smoking can also get a screening for aneurysm.

Part B pays for 100% of screenings and 80% of all other follow-up visits or outpatient services after you have satisfied the annual Part B deductible of $185.

Diagnosis and Treatment of Heart Disease

Medicare will cover these tests ordered by your Medicare doctor, including scans, stress tests, echocardiograms and cardiac catheterizations. When it comes to diagnosis and treatment of heart disease or any other illness, Medicare generally covers medically necessary services.

Part B will again cover 80% of any tests or procedures that are performed on an outpatient basis. Part B may also cover a cardiac rehab program. This typically involves education and counseling for a healthier lifestyle and an exercise program monitored by a physical therapist in either a hospital outpatient setting or physician’s office.

However, if you are hospitalized or need surgery, Medicare Part A will cover an inpatient hospital stay as well as any skilled nursing. When you enter the hospital, you will trigger a new benefit period. There is a Part A deductible of $1,364 per benefit period in 2019. After this, Medicare covers all medically necessary allowable charges for the first 60 consecutive days in the hospital.

What Else Does Medicare Cover for Heart Disease?

Your doctor may prescribe medications to treat your heart disease. If you are enrolled in a Medicare Part D drug plan, your plan will likely cover these medications. You will be responsible for an annual deductible of up to $415 as well as any medication copays or coinsurance.

Beginning in 2019, some Medicare Advantage plans will begin including supplemental benefits that could be helpful for people with chronic illnesses. Individuals who are trying to quit smoking can qualify for nicotine replacement therapy.

Other new benefits may include transportation to medical appointments, meal delivery, in-home support services for activities of daily living and even home safety modifications.

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