Medicare Coverage for Heart Disease: From Prevention to Cardiac Rehab

Heart disease is the leading cause of death in the United States -- and the most costly condition in Medicare. Approximately 29% of Medicare beneficiaries have coronary artery disease, heart failure, or another cardiovascular condition. Medicare covers a comprehensive range of services for heart disease prevention, diagnosis, and treatment.

Medicare covers cardiovascular disease prevention at no cost:

Cardiovascular screening blood tests: Cholesterol, lipid panel, and triglycerides -- every 5 years at no cost.

Cardiovascular disease behavioral therapy: One visit per year with your primary care doctor to discuss aspirin use, blood pressure management, and dietary counseling -- at no cost for people at increased cardiovascular risk.

Blood pressure screening: Covered as part of the Annual Wellness Visit at no cost.

Intensive behavioral therapy for obesity: For beneficiaries with BMI ≥ 30 -- up to 22 sessions per year at no cost. Obesity is a major cardiovascular risk factor.

When heart disease is suspected or monitored, Medicare covers:

• Electrocardiogram (EKG/ECG): Covered as part of the Welcome to Medicare visit; also covered when medically indicated
• Echocardiogram: 20% coinsurance after Part B deductible
• Stress test (exercise or pharmacologic): 20% coinsurance after Part B deductible
• Cardiac catheterization: 20% coinsurance after Part B deductible (outpatient); Part A for inpatient
• CT coronary angiography: 20% coinsurance after Part B deductible
• Holter monitor and event monitors: 20% coinsurance after Part B deductible

Inpatient hospitalization for heart attack, unstable angina, or acute heart failure is covered under Part A:

• Emergency care and stabilization
• Cardiac catheterization and coronary angiography
• Percutaneous coronary intervention (PCI) -- balloon angioplasty and stent placement
• Coronary artery bypass graft (CABG) surgery
• ICU monitoring
• Medications administered during hospitalization

Cost: Part A deductible per benefit period ($1,484 in 2021). Medigap Plan G covers this deductible.

After a qualifying cardiac event, Medicare covers cardiac rehabilitation -- a supervised program of exercise, education, and counseling that significantly reduces mortality and rehospitalization.

Qualifying events for cardiac rehab:

• Heart attack (myocardial infarction) within the past 12 months
• Coronary artery bypass surgery
• Current stable angina pectoris
• Heart valve repair or replacement
• Percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting
• Heart or heart-lung transplant
• Stable, chronic heart failure (with ejection fraction ≤ 35%)

Coverage: Up to 36 sessions over 18 weeks; up to 72 sessions with medical necessity documentation.

Cost: 20% coinsurance after the Part B deductible. Medigap Plan G covers this 20%.

Medicare covers implantable cardiac devices when medically indicated:

• Pacemakers: Covered under Part A (inpatient implantation) or Part B (outpatient)
• Implantable cardioverter-defibrillators (ICDs): Covered for qualifying patients with reduced ejection fraction
• Cardiac resynchronization therapy (CRT): Covered for qualifying heart failure patients
• Implantable loop recorders: Covered for unexplained syncope or arrhythmia evaluation

For beneficiaries with heart failure, Medicare covers:

• Regular physician visits for monitoring
• Echocardiograms to assess ejection fraction
• Medications (Part D): ACE inhibitors, ARBs, beta-blockers, diuretics, SGLT2 inhibitors
• Remote monitoring devices (in some circumstances)
• Chronic Care Management for coordinated care

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.