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Does Medicare Cover Heart Disease?

January 25, 2024

A nurse with a stethoscope checks a patient's heart beat.

February is American Heart Month - a way to bring awareness to heart disease and help spread tips on heart disease prevention. That means now is the perfect time to review some of the facts about cardiovascular disease (CVD), along with tips to combat it. Then we’ll dive into how Medicare can help you prevent, treat or manage cardiovascular diseases. 

What Is Heart Disease?

Heart disease is the leading cause of death in the United States. Heart disease, also known as cardiovascular disease CVD, is a broad term for several different medical conditions.

But generally speaking, heart disease is an illness that affects the heart or circulatory system. The illnesses that fall under the heart disease category include:

  • Coronary artery disease (CAD)
  • Heart rhythm problems
  • Congenital heart disease
  • Infections of the heart tissue
  • Heart valve disease

Cardiovascular Disease Risk Factors

Many of the biggest risk factors of cardiovascular disease are lifestyle related. And while there’s a general assumption that these factors are the sole cause, many people are actually born with heart disease. It can be congenital and hereditary.

But those with lifestyle risk factors have control over heart disease prevention. The main risk factors and causes of heart disease include:

  • Obesity
  • High cholesterol
  • Diabetes
  • Smoking
  • High blood pressure
  • And these causes of heart disease can be directly tied to such behaviors as:
  • Poor diet
  • Poor physical activity
  • Too much alcohol
  • Tobacco use
  • Genetics or heredity

Simply put, the lifestyle habits (good or bad) that we form are what lead to the major risk factors for cardiovascular disease. Genetics and heredity may then play a role in whether or not we actually develop heart disease.

4 Tips To Prevent Cardiovascular Disease CVD

The fact that many of the risk factors for CVD are lifestyle related and preventable. This means we can make smart choices and avoid unhealthy behaviors to protect our hearts. This in mind, here are 4 healthy habits to maintain good heart health.

#1. Stop Smoking

Quitting smoking is almost universally hailed as the biggest step to reduce your risk of heart disease. Smoking is considered the most easily avoidable lifestyle factor that leads to cardiovascular disease. So if you currently smoke, make an attempt to stop now. Quitting smoking will also save you money, making this heart disease prevention tip a no-brainer.

#2. Eat Healthy

Diet also plays a big role in the health of your heart. A poor diet multiplies and compounds risk factors, but a smart, healthy diet can reduce your risks and get your heart in great shape.

You should always speak with your doctor about nutrition and heart healthy diet options. But generally speaking a heart healthy diet may include:

In addition to eating these nutritious foods, another suggested tip is to limit your saturated fat, sodium, and sugar intake. This type of diet fits into the DASH (Dietary Approaches to Stop Hypertension) eating plan.

#3. Stay Active

There’s no getting around the fact that an active lifestyle is a healthy one. But you don’t have to jump right in and overdo it. In fact, gentle but steady exercises can be great way to help prevent heart disease, including:

  • Walking 30 minutes per day
  • Cycling
  • Swimming

The main point is to pick an activity that you enjoy. So if you have a scenic path, beach, or lake nearby, consider talking walks or riding your bike there. You should also have a backup plan for poor weather or to keep safe and healthy during COVID-19. Research home workout apps or programs on platforms like YouTube or you Smart TV.

But just remember: If you over-commit to exercise and activity, you may fall off the wagon completely. Instead, start small, and add time and distance gradually. If you make it a firm part of your routine, you’ll stick to it.

Again, always be sure to consult your doctor before developing an exercise or activity regimen for heart health.

#4. Stay Informed About Your Cardiovascular Disease CVD Risks

One of the most important heart disease prevention tips is to stay proactive and empowered about your own personal health. This is especially true if you have a family history or genetic predisposition. Here are some key strategies:

  • Don’t miss or delay your doctor’s appointments.
  • If recommended, make sure you get cardiovascular screenings and tests.
  • If you’re on heart disease medications, be sure to consistently take them and follow your treatment plan.
  • Ask questions and be proactive when it comes to your health and wellbeing.

How Does Medicare Cover Cardiovascular Disease CVD?

If you’re on Medicare or aging into Medicare and cardiovascular disease prevention is important to you, know that all aspects of the Medicare program cover heart disease related measures. This includes Medicare cardiovascular screening, treatment, and healthy lifestyle tools.

Heart disease prevention and treatments are covered by:

In the most basic sense, Medicare will cover all the stages of cardiovascular disease, including:

  • Annual screenings (covered by Part B)
  • Doctor’s visits, both primary and specialists (covered by Part B)
  • Heart condition medications (covered by Part D)
  • Cardiovascular tests and procedures (covered by Part B)
  • Hospitalizations (when admitted as an in-patient, covered by Part A)

When you use Medicare Part A coverage under Original Medicare, your costs may include:

  • Monthly premium: Varies based on Medicare taxes paid during your employment.
  • Inpatient hospital deductible: $1,632 per benefit period in 2024
  • Coinsurance (days 61 to 90): $408 per day in 2024
  • Daily hospital coinsurance for lifetime reserve days: $816 in 2024

When you use Medicare Part B coverage under Original Medicare, you can expect to pay:

  • Part B monthly premium: $174.70 in 2024 (or higher depending on your income)
  • Part B deductible: $240 in 2024
     

Medicare Cardiovascular Screenings

Medicare covers cardiovascular screenings, which involves a blood test once every five years.

But if your doctor orders more frequent cardiovascular screenings and tests, Medicare will cover them. However, you’ll pay your share of costs as we outlined above.

Medicare Cardiac Rehabilitation Programs

Medicare Part B will cover part of the costs for cardiovascular disease rehabilitation programs. These covered programs include exercise, education, and counseling designed to maintain your heart health.

Note: Medicare Part B will cover these cardiac rehabilitation programs, only if any of these scenarios apply to you:

  • You’ve had a heart attack in the last 12 months.
  • You’ve had heart bypass surgery.
  • You’re experiencing stable angina or chronic heart failure.
  • You’ve had a heart of lung transplant.
  • You’ve had a valve or artery repair or replacement.

Once again, you’ll pay your standard 20% coinsurance if you use these cardiac rehab programs under Medicare Part B.

Cardiac Tests Covered By Medicare

Beyond standard cardiovascular disease screenings and rehabilitation programs, Medicare will cover medically necessary cardiac tests ordered by your doctors. These types of heart tests may include:

  • Blood tests
  • Echocardiograms (ECG)
  • Exercise stress tests
  • MRI or x-rays

Just as with the other services, you’ll pay 20% cost-sharing under Part B of Original Medicare.

Cardiovascular Medications

Most prescription drugs are not covered by Original Medicare. But you may be able to get heart and cardiovascular prescription drug coverage through a Medicare Part D plan.

The 2 types of Medicare plans that offer Part D:

  • Standalone Prescription Drug Plans (PDP) and
  • Medicare Advantage plans that include Prescription Drugs (MAPD)

It’s important to note that not all drugs are covered by all Medicare Part D drug plans. However, all Part D plans must cover at least two drugs in every therapeutic category, including heart disease or cardiovascular disease.

Tip: You can use our prescription lookup tool to see if your drugs are covered under Medicare Part D.

Medicare Chronic Conditions and Disease Management Programs

If you have more than one chronic condition, you may qualify for special disease management programs. These are covered by Original Medicare, but you’ll still be responsible for your standard cost sharing. You may also have to pay a monthly fee to participate in these chronic care management services.

Under these management programs, you’ll work with your healthcare professionals to craft a comprehensive health plan tailored to your heart condition. A chronic care management plan may include:

  • Goal setting and health evaluations
  • Working with all of your specialists
  • Managing your medications

The Benefits of Stroke and Cardiovascular Disease Risk Screenings

Preventive health screenings, such as cardiovascular risk screenings, are another way to take steps to detect problems early on and improve your overall health. In fact, according to the American Heart Association, 80% of cardiovascular diseases - including heart disease and stroke - is preventable.

That's where preventive screenings come into play: These screenings arm people with important health information so they can work with their physicians to take action before it’s too late.

And as we covered, lifestyle changes like improving your diet and exercising more often can help lower chronic disease risks. Other interventions, such as medications to lower blood pressure or surgery to treat a clogged artery, may be necessary based on physician feedback.

Who Should Get Cardiovascular Disease Screenings?

Screenings are recommended for anyone age 50 and older or age 40+ with one of the following risk factors: high blood pressure, high cholesterol, diabetes, obesity, smoking, family history of stroke or cardiovascular disease.

Conclusion: Medicare and Cardiovascular Disease Coverage

With lifestyle and healthy habits, you can control many factors that may lead to cardiovascular disease. And if you currently have heart disease, you can manage your condition with a healthy lifestyle and tests, specialists, and medications covered by Medicare.

To make the most of your private Medicare coverage (Medicare Advantage or Prescription Drug Plan coverage):

  • Check to ensure your medications are covered by the plan you’re considering.
  • Make sure you’ll remain in-network with your doctors and specialists.

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