Navigating Medicare can be confusing, especially if you are dealing with a chronic condition. If you have or are at risk of chronic cardiovascular disease, your health may require additional support than is available through Original Medicare. Learning about your coverage and benefit options can help you make an informed decision.
Original Medicare and Heart Disease (Cardiovascular Disease) Coverage
Medicare Parts A and B will cover some services if you are at risk of, or have, cardiovascular disease or have suffered a heart attack.
Medicare Part A (hospital coverage) will cover inpatient care. For example, Part A will cover heart bypass surgery. Your cost of heart bypass surgery with Medicare is the 20 percent coinsurance and the inpatient hospital deductible if not met yet. Medicare Part A will also cover an implantable defibrillator if you have been diagnosed with heart failure and the procedure takes place in a hospital. (Some of the in-patient costs are likely to be covered by Part B.)
Medicare Part B (medical insurance) will cover:
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Cardiovascular disease screening (once every 5 years)
Blood tests to detect cardiovascular conditions
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Cardiovascular behavioral therapy (once per year)
Therapy to help lower your risk for cardiovascular disease
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Cardiac Rehabilitation, if you meet eligibility requirements
Exercise, education and counseling after a heart attack, heart transplant, coronary artery bypass surgery, chronic heart failure, angina, or coronary angioplasty.
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Implantable defibrillator, if you have been diagnosed with heart failure and the procedure takes place in an outpatient setting
For most Part B covered Medicare services, you are responsible for the 20 percent Medicare coinsurance.
It’s important to note that if you are at risk, your doctor may recommend screening more often than Medicare covers. In that case, you will be responsible for 100 percent of the non-covered cost.
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Additional Benefits with Medicare Advantage
Original Medicare (Parts A and B) does not include coverage for numerous important benefits that individuals dealing with heart and cardiovascular disease may desire, including:
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Vision
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Dental
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Hearing
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Prescription Drugs
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Home Health Care Services
Medicare Advantage Part C is offered by private insurance companies and includes all of the coverage of Original Medicare. Many Medicare Advantage plans come with additional coverage, like the ones listed above, as well as potential additional savings. Because many Medicare Advantage plans include Part A, Part B, Part D, as well as additional benefits in a single plan, you may find that managing your Medicare coverage is more convenient.
If you have or are at risk of cardiovascular disease, you may find that a Medicare Advantage plan is financially beneficial. Many Medicare Advantage plans are known to have low to no cost premiums, deductibles or copayments. You will still be responsible for the Part B premium. Because many Medicare Advantage plans include Part D prescription drug coverage, you may find that your prescription medications cost less.
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Chronic Special Needs Plans (C-SNP) for Heart Disease and Cardiovascular Disorders
Some Medicare Advantage plans are designed to cater to people with specific chronic conditions. These plans are called C-SNPs. Some plans are geared toward heart disease and cardiovascular disorders, which means they may offer better access to cardiology specialists and cover common prescriptions used by individuals with a heart or cardiovascular disease.
Frequently Asked Questions
Cardiovascular disease is an umbrella term that can refer to several conditions, including:
- Heart failure
- Cardiomyopathy
- Coronary artery disease
- Angina
- Tachycardia
Some Medicare Advantage C-SNPs cater to specific cardiovascular conditions.
Enrollment Eligibility
Annual Enrollment Period (AEP)
Medicare Annual Enrollment Period runs each year from October 15 to December 7. What is the Annual Enrollment Period vs. Open Enrollment Period?
Initial Enrollment Period (IEP)
Your Initial Enrollment Period generally surrounds your 65th birthday but may occur if you otherwise become eligible for Medicare for the first time.
Special Enrollment Period (SEP)
You may be eligible if you experience a qualifying life event such as moving to a new zip code, losing employer coverage, or change in Medicaid status.
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Further Reading:
What is Medicare Part D? | Prescription Drug Plans
Original Medicare vs. Medicare Advantage
