What is heart disease? Also called cardiovascular disease, several conditions qualify—including problems with the arteries, valves, and heart muscle.
Millions of Americans live with some form of heart disease right now, including the vast majority of Medicare recipients. Could you be one of them?
Cardiovascular screenings can be a useful tool for early detection and ongoing management. Learn what services Medicare will cover.
According to the American Heart Association (AHA), more than 121 million adults in the United States live with some form of heart disease.
Also called cardiovascular disease, or CVD, heart disease is a broad term that includes a variety of conditions that could lead to heart attack or stroke, such as:
- Coronary artery disease
- Irregular heartbeat
- Problems with the heart valves
- Problems with the heart muscle
- Hereditary (congenital) defects
Heart disease is a serious concern for anyone. Still, older adults face a statistically higher risk for it than their younger counterparts.1 That’s because certain contributing factors—such as functional changes in the way the heart works, decreasing levels of certain hormones, and even obesity and diabetes—can go hand-in-hand with advancing age.
But there’s good news. When found early, heart disease is much easier to treat and manage than when it’s in a later stage. That’s why it’s important to ask your health care provider whether regular cardiovascular screenings and cardiovascular risk reduction visits make sense for you. In addition to adopting healthy lifestyle habits such as getting the right kinds of exercise and following a heart-healthy diet, these evaluations can be among the most important tools to have in your kit when it comes to preventing or living with heart disease.
They can also save you money, explained Brandy Bauer, director of NCOA’s MIPAA Resource Center.
“Collectively, cardiovascular disease costs Americans nearly $230 billion each year,” she said. “That includes the costs of care and prescription drugs, as well as lost income due to disability or death. Being proactive about taking care of your heart simply makes sense: both for your physical health and for your financial well-being.”
Of course, this all begs an important question:
Does Medicare cover heart disease?
The answer is particularly relevant for older adults, especially since the AHA says that that the vast majority of Medicare beneficiaries have some form of CVD.
“Generally speaking, Medicare does pay for a variety of screenings, services, and treatments related to cardiovascular health,” said Bauer. “The specifics will differ depending on each person’s plan, though, which is why it’s a good idea to check the outline of coverage before scheduling an appointment.”
In this handy FAQ, we cover some of the most common questions related to Medicare and heart disease.
What is a cardiovascular screening?
During a cardiovascular screening appointment, your doctor will run blood tests to check your cholesterol, lipid, and triglyceride levels, all of which can impact coronary artery health. And during a risk reduction visit, your doctor will measure your blood pressure and advise you on non-prescription strategies for preventing heart disease or its serious effects.
Does Medicare cover cardiovascular screenings?
Yes, with certain caveats.2
Original Medicare Part B (medical insurance) will pay 100% of the costs for cardiovascular screening blood tests once every five years when you see a participating provider. Medicare Advantage plans (private insurance) also must fully cover these screenings, as long you see an in-network provider and you meet Medicare’s eligibility requirements.
“Keep in mind that your health care provider may identify additional concerns during a heart disease screening visit, which may or may not be covered,” Bauer said. “If you need to have more tests, be sure to ask whether you’ll be responsible for any deductibles, co-pays, or other out-of-pocket costs.”
Does Medicare cover cardiovascular risk reduction visits?
Yes, once per year if you have Original Medicare Part B and see a participating provider.3 You do not need to show any signs or symptoms of heart disease in order to take advantage of this screening.
Similarly, Medicare Advantage plans will cover 100% of the costs of these screenings each year when you see an in-network provider and meet Medicare’s eligibility requirements.
Does Medicare cover cardiologist visits?
Yes, but it depends, Bauer cautioned.
Medicare Part B will pay for outpatient cardiology care once you have met your deductible. That said, “not every provider will accept Medicare’s approved amount as full coverage for the care you receive,” she explained. For example:
- Participating providers agree to accept Medicare’s payment in full. (You may still be responsible for paying co-insurance).
- Non-participating providers still accept Medicare but will likely charge you additional fees. These can be up to 15% more than what Medicare pays for services, and you may also still be responsible for paying co-insurance.
- Opt-out providers do not accept Medicare at all, so none of the services you receive will be covered.
If you’ve been diagnosed with heart disease and are referred to a cardiologist, be sure to ask up front whether they are a participating, non-participating, or opt-out provider. This will help you better anticipate and plan for any out-of-pocket costs you may incur.
Does Medicare cover chronic heart disease?
If you have two or more serious health conditions, Medicare Part B will pay for coordinated care services to help you better manage them. These conditions must be chronic—meaning you expect them to last 12 months or more—and they must put you at significant risk for disability or death. Heart disease, diabetes, asthma, and arthritis fall into this category.4
It’s important to note that you will still be responsible for any deductibles, co-payments, and co-insurance for chronic care management. Some providers may also charge a monthly fee.
I have more questions about Medicare. Where can I get help?
NCOA’s Age Well Planner provides free, personalized guidance. Visit today to connect with a licensed Medicare enrollment specialist who meets our Standards of Excellence for clear communication, unbiased education, and practical support.
1. Jennifer L. Rodgers, et al. Cardiovascular Risks Associated with Gender and Aging. Journal of Cardiovascular Development and Disease. June 2019. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6616540/
2. Medicare Rights Center. Heart disease screenings. Medicare Interactive. Found on the internet at https://www.medicareinteractive.org/get-answers/medicare-covered-services/preventive-services/heart-disease-screenings
3. Medicare Rights Center. Cardiovascular disease risk reduction visits. Medicare Interactive. Found on the internet at https://www.medicareinteractive.org/get-answers/medicare-covered-services/preventive-services/cardiovascular-disease-risk-reduction-visits
4. Medicare Rights Center. Care management for chronic conditions. Medicare Interactive. Found on the internet at https://www.medicareinteractive.org/get-answers/medicare-covered-services/outpatient-provider-services/care-management-for-chronic-conditions