Medicare Coverage of Heart Disease

We are fortunate to have another guest post from Medicare expert, Danielle Kunkle, who has provided us with a helpful explanation of how your Medicare benefits cover your medical expenses if you develop heart disease.  This is important information, because heart disease is one of the top causes of death for senior citizens.  It is also important for retirees on Medicare to understand that your coverage will vary depending on whether you have Original Medicare only, a Medicare Advantage plan, or Original Medicare plus a Medicare supplement (Medigap) plan.  Danielle Kunkle's post provides information which is likely to affect nearly everyone during their retirement years. 

How Does Medicare Cover Heart Disease?

Heart disease is a broad term which covers a lot of different conditions which affect the heart and blood vessels. It’s the number-one killer of both men and women in the United States, according to The Heart Foundation. More people die of heart disease, also called cardiovascular disease, than from all types of cancer combined.

Although a heart disease diagnosis is serious, there are things you can do to treat it and lower your risk of serious complications. The good news is that there are Medicare benefits for people with heart disease or who are at risk of developing it.

What is Heart Disease?

Heart disease shows up in different ways in the body. It may cause a heart attack, stroke, or heart rhythm problems, for example. According to the American Heart Association, most of these heart conditions are caused by atherosclerosis.

Atherosclerosis develops when fatty substances, called plaque, build up on the walls of the blood vessels. The plaque narrow the vessels, making it difficult for blood to flow freely. Often, the plaque ruptures and causes blood clots to form.

When a blood clot blocks the flow of blood to a part of the heart, a heart attack occurs. If the clot interrupts blood flow to parts of the brain, it causes an ischemic stroke.

How is Heart Disease Diagnosed?

 

Some of the most common risk factors for heart disease include:

●       Smoking

●       High blood pressure

●       High cholesterol

●       Diabetes

●       Being overweight

If you are at high risk for developing heart disease, your doctor may order screening and diagnostic tests. These might include blood tests for cholesterol and triglycerides, blood pressure checks, and lab work to rule out diabetes.

If you have symptoms of heart disease, your doctor may order other tests to confirm the diagnosis. You may have an electrocardiogram (ECG), an ultrasound of the heart, a stress test, or even an MRI or CT scan. In some cases, you may have cardiac catheterization, an outpatient procedure which lets the doctor see your heart and blood vessels to check for abnormalities.

What Does Medicare Cover? 

PartB covers cholesterol screening blood tests once every five years at no cost to you if your doctor accepts Medicare assignment. If you have symptoms of heart disease, Medicare may pay for a diagnostic cholesterol test, if your doctor thinks it is medically necessary. You pay 20% of allowable charges once you meet your deductible. You may also qualify for heart disease counseling with your doctor once each year at no cost to you.

If you have risk factors for diabetes, Medicare may pay for two screening exams a year at no cost to you if your doctor accepts assignment.

Part B generally pays for any diagnostic tests and exams your doctor thinks are medically necessary based on your symptoms and risks for heart disease. You pay your 20% coinsurance after you’ve met your deductible. 

How is Heart Disease Treated?

 

There’s no one-size-fits-all treatment for heart disease. Your doctor may recommend any combination of the following types of treatment, depending on your exact condition and how severe it is:

●       Changes in lifestyle to lower your risk of life-threatening complications. This may include losing weight, reducing the fat and cholesterol in your diet, and exercising more. If you smoke, your doctor will help you try to quit.

●       Prescription medications to control your disease and risk factors. Your doctor may recommend medications to treat high blood pressure, lower the cholesterol in your blood, or better manage your blood sugar.

●       Surgical procedures to repair damage. If the heart disease is severe, you may need angioplasty, stent placement, or even cardiac bypass surgery.

What Different Medicare Plans Will Cover

Depending on where you get treatment, Part A or Part B covers medically necessary heart disease treatment. For example, if you are hospitalized for heart surgery, Part A pays after you meet your deductible. You may also have coinsurance if your stay goes beyond 60 days. If you get outpatient treatment, Part B pays for your care.

If you smoke, Part B covers 8 face-to-face smoking cessation sessions each year with a qualified provider. If your provider accepts assignment, you pay nothing for these sessions.

You may also qualify for weight loss counseling if you are very overweight. Again, these are covered 100% under Part B if your provider accepts Medicare assignment.

Depending on the type of heart disease you have, your doctor may recommend a cardiac rehab program. If you qualify, Part B will pay 80% of the allowable charges after your deductible is met.

Unfortunately, most prescription medications to treat heart disease aren’t covered under Original Medicare. If you have Medicare Part D coverage for prescription drugs, your heart disease medications are likely covered.

If you have a Medicare Advantage plan, you may have extra benefits beyond Part A and Part B. Medicare Advantage plans are offered by private insurance companies approved by Medicare. They must cover everything that Original Medicare covers at a minimum, but they often have other benefits helpful to people with heart disease. For example, your plan may cover Silver Sneakers, which gives you free access to participating gyms. Most Medicare Advantage plans also include Part D prescription drug coverage. Some may even help with over-the-counter medications such as aspirin your doctor recommends for heart disease.

If you have Original Medicare and worry about your out-of-pocket costs for heart disease treatment, you may want to consider a Medicare Supplement Plan. These plans pay some or all of your Part A and Part B costs after Medicare pays. They don’t, however, pay your Part D prescription drug costs.  You can purchase a separate plan to help with drug expenses.

About the author:

Danielle Kunkle is the co-founder of Boomer Benefits, an insurance agency specializing in Medicare-related insurance products.  They help baby boomers new to Medicare learn about their benefits and coverage options across 47 states.

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