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