Heart Disease and Medicare: How Are You Covered in 2019?

Contributed by Danielle Kunkle.

Heart disease is a catch-all term for many different conditions that affect your heart. The most common, coronary heart disease (CHD) is caused by fatty deposits narrowing the arteries that supply the heart. Other types of heart disease are caused by abnormalities in the heart structures themselves, weakness in the heart muscles, or problems with the signals that maintain a normal heart rhythm.

Heart disease causes one in four deaths in the U.S.; it’s the leading cause of death for both men and women. Over 700,000 people have a heart attack every year, and heart disease contributes to nearly 800,000 strokes each year.

Health and lifestyle factors such as hypertension, obesity, diabetes, high cholesterol, smoking, heavy alcohol use, and a lack of physical exercise are all risk factors for developing heart disease. The Centers for Disease Control states that 47% of Americans have at least one risk factor for heart disease.

If you have heart disease, or risk factors for heart disease, and you are covered by Medicare, here’s what you need to know about your coverage in 2019.

Does Medicare cover heart disease screening?

Undiagnosed and untreated heart disease causes debilitating and life-threatening complications. The good news is that Medicare covers a number of tests and screening procedures to identify heart disease early so you can get the treatment you need.

Aortic aneurysm screening

Medicare pays 100% of costs associated with screening for abdominal aortic aneurysms if you have a family history of aortic aneurysm or are a male between the ages of 65 and 75 with a history of smoking.

Blood pressure screening

Blood pressure screening is included in your Medicare Welcome visit and annual wellness visits. If you are diagnosed with hypertension, Part B covers your doctor visits to supervise and treat your high blood pressure.

Cholesterol screening

Medicare pays for cholesterol screening once every five years. If you have heart disease or are diagnosed with high cholesterol, Medicare will cover additional blood work to monitor your condition; you pay 20% of allowable charges.

Does Medicare cover tests to diagnose heart disease?

Your doctor may order additional tests based on your heart disease screenings or other symptoms you have that may suggest heart disease. These may include blood tests, imaging studies such as x-rays, CT scans, echocardiograms, and MRIs, electrocardiograms, stress tests, or even direct heart visualization with cardiac catheterization.

Medicare covers allowable charges for any medically necessary diagnostic tests your doctor orders. Part B covers 80% of lab work and tests performed on an outpatient basis, after you meet your Part B deductible. If you are hospitalized for diagnostic procedures, Part A pays after you meet your deductible.

Does Medicare cover treatment for heart disease?

Treatment for heart disease usually involves a combination of medication and lifestyle changes, and may require surgical treatment in certain cases. Medicare covers your doctor visits and medically necessary surgical treatment for heart disease; your Part A and Part B deductibles apply.

Original Medicare (Part A and Part B) generally does not cover any prescription medications you take at home for heart disease. However, if you have Part D prescription drug coverage, your plan will likely cover any medications your doctor prescribes to treat your heart disease. You may have an annual deductible and copayment or coinsurance with your prescription drug plan.

If you smoke, your doctor may prescribe smoking cessation counseling or medications. Part B covers up to 8 smoking cessation sessions a year; you pay nothing if your provider accepts assignment. If you are overweight, Medicare also pays for weight loss counseling to help you achieve a healthy weight.

You may also qualify for Part B coverage of a cardiac rehab program, which includes exercise, education, and counseling. Medicare will pay for cardiac rehab in a doctor’s office or hospital outpatient setting if you have had a heart attack, bypass or valve surgery, heart failure, or angina, as long as you meet other requirements.

What’s new for 2019?

In 2019 and 2020, many Medicare Advantage plans are rolling out new supplemental benefits that may help people with heart disease. For the first time, Medicare Advantage plans may cover nicotine replacement therapy such as patches or gum for people who want to quit smoking. There is also coverage for over-the-counter medications and medical devices such as blood pressure monitors.

There are benefits for meal delivery at home, non-medical transportation to and from health care appointments, home safety devices such as bathroom grab bars, and even personal care visits for help with bathing, dressing, meal preparation, and even housekeeping. If you have severe heart disease or are recovering from cardiac surgery, these benefits could be very helpful.

Not all plans will offer all the supplemental benefits, but more are expected to add them in 2020.