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Medicare Coverage for Heart Disease Treatment: What Are Your Options?

A Broken Heart is a Serious Problem

Here’s a chilling statistic. Even though the COVID-19 pandemic was responsible for over 350,000 deaths in the US in 2020, heart disease remained the leading cause of death by a significant margin. We’re talking nearly double. As terrifying as COVID is, it doesn’t even come close to the death toll of heart failure. Needless to say, our cardiac health is a major concern, especially as we get older. That’s why your doctor will prescribe countless tests on your cholesterol, blood pressure, and heart rhythm to identify any symptoms of heart disease before it’s too late. 

Both Original Medicare and Medicare Advantage cover heart disease treatment, but navigating which parts cover what services can be confusing. Luckily, we’re here to help.

Preventive Cardiac Care

Blood Pressure Testing

This is going to sound obvious, but the best way to survive any disease is to avoid getting sick in the first place. That’s why so many Medicare services are centered on screening for and lowering the risk of heart disease. If healthcare providers catch a warning sign, like high cholesterol or an irregular heartbeat, they can intervene before the problem escalates to something life-threatening. 

Most preventive services are covered under Medicare Part B, as they’re offered on an outpatient basis. These preventive services are typically covered at no cost to you, though more frequent testing will likely incur a co-payment of some sort. 

Every five years, beginning from your initial enrollment, Medicare will cover a routine cardiovascular screening. This test will check your lipids, cholesterol, and other risk factors for heart disease.

Most of us are familiar with coronary heart disease. This occurs when lipids build up in the veins, forming a clot that prevents the flow of blood. Coronary heart disease treatment and prevention involves preventing these clots from forming and clearing the flow of blood through stents and bypasses. This is the most common form of heart disease, and the one most frequently tested for.

You might also be tested for congestive heart failure. This is a closely related illness that occurs when the heart is unable to pump blood as well as it should due to weakness, damage, or build-up of lipids. Congestive heart failure treatment is often done through medications, though surgery may be required in more severe cases.

Rheumatic heart disease is the result of inflammation by rheumatic fever. It is a chronic, but preventable disease that often results from untreated strep throat or similar illnesses. Your body’s immune system will, in an effort to defeat the infection, cause damage to your heart valves. Rheumatic heart disease treatment involves surgically replacing the damaged valves or even the entire heart in extreme cases. Fortunately, it is entirely preventable with modern antibiotics.

Cardiac arrhythmia is when your heartbeat is irregular, and is diagnosed with an electrocardiogram (ECG or EKG). Arrhythmia is treated by correcting your heart rhythm with therapy, medication, a device like a pacemaker, or surgery. Arrhythmia has many of the same risk factors as coronary heart disease, but can also be the result of genetics.

Be Aware: Some malicious actors will contact you offering a “Free Medicare Heart Disease Test Kit”, or will otherwise offer a service using similar language. This usually refers to a type of genetic test that can be performed at home. While genetic testing is a way to help identify your risk for heart disease, Medicare will only cover such tests when recommended by an in-network cardiologist. Someone contacting you out of the blue offering a test is just trying to get your Medicare information, which they will likely use to commit fraud. Protect yourself: speak with your doctor before consenting to any medical procedure or test.

Your doctor might also recommend a yearly cardiovascular behavioral therapy visit. This involves a blood pressure check, an evaluation for aspirin use, and other forms of heart disease treatment such as diet counseling. 

Depending on the results of your regular examination, your doctor may recommend medications to manage cholesterol or blood pressure. These are, unfortunately, not covered under Original Medicare. As with all prescription medications, you will need either a Medicare Part D plan or a Medicare Advantage plan that covers prescription drugs in order to receive coverage. 

When an emergency strikes

Coronary clot

Unfortunately, even with careful preparation, a heart attack can still strike when you least expect it. For this reason, it’s important to keep on the lookout for the symptoms of heart disease, which may include:

  • Chest pain

  • Dizziness

  • Nausea

  • Shortness of breath

  • Extreme tiredness

If you suspect you are having a heart attack, call 911 immediately. 

Your hospitalization, including transportation, food, lodging, and any procedures you undergo, will be covered under Medicare Part A. You will need to pay coinsurance and a deductible for this visit under Original Medicare, though a Medigap or Medicare Advantage Plan may cover some of the cost-sharing burdens. 

After your discharge, Medicare Part B will also cover cardiac rehabilitation: a long-term program of diet, counseling, and exercise designed to restore your heart health. 

How Medicare Advantage Can Help

An AED being used on a training dummy

Original Medicare supplemented with Medicare Part D is, in most cases, more than sufficient for covering an acute cardiac event. Those with chronic conditions, however, might want more comprehensive coverage. 

Medicare Advantage Special Needs Plans (SNP) are offered for a variety of conditions, like lung cancer and diabetes. Cardiovascular disorders and chronic heart disease are also covered by dedicated SNPs in many cases. These plans offer all the benefits of Original Medicare and Medicare Part D, but with tailored coverage for your condition. This can include more frequent testing, extra coverage for hospital stays, and coverage for specific treatments or equipment like an automatic electronic defibrillator (AED). 

If you are unsure if you qualify for an SNP, our licensed insurance agents can help. Give us a call at (800) 950-0608 today. We’ll help you understand what options are available in your area, and what coverage you might qualify for.

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