Medicare & Cardiovascular Disease: Screening, Coverage, and Cost

Medicare & Cardiovascular Disease: Screening, Coverage, and Cost

Cardiovascular refers to the blood vessels and the heart. Any disease that affects the cardiovascular system is called cardiovascular disease, such as heart stroke or heart attack.

According to the CDC (Centers for Disease Control and Prevention), cardiovascular disease is the top cause of death in the United States.

The most frequent form of coronary disease is coronary artery disease. In this condition, the blood vessels transporting blood to the heart get narrowed or blocked because of the fat deposition, also known as plaque.

If an artery that supplies blood flow to your heart has been blocked, it triggers a heart attack. On the other hand, an artery that supplies blood to the brain is cut off, leading to a stroke.

Cardiovascular disease is a broad word that describes various ailments that could harm your heart, including:

  • the coronary heart condition (CAD)
  • Heart arrhythmias; can be described as abnormal beats (rhythm disorders)
  • heart valves failure
  • Cardiomyopathy; heart’s wall weakness identifies the condition. 

Medicare covers a range of cardiovascular diseases, rehabilitation, and behavioral education services. Your insurance plan’s covered treatment and services, and your health requirements determine the amount you pay for Medicare insurance.

Medicare Coverage for Cardiovascular Treatment

The different parts of Medicare provide different coverages at their level. Here’s what each part covers;

Original Medicare (Part A & B)

Original Medicare has two parts Part A (Inpatient Coverage, i.e., hospitalization insurance) and Part B (Outpatient Coverage, i.e., Medical Coverage).

Part A includes:

  • Heart conditions require surgical intervention, like a coronary bypass.
  • Heart procedures, like cardiac catheterization.
  • Other Cardiovascular illness that requires hospitalization

Part B includes:

  • Screenings
  • Doctors’ appointments
  • Diagnosis, such as echocardiograms, scans, and stress tests.
  • Cardiac Rehabilitation Program

Medicare Advantage

Medicare Part C or Medicare Advantage is an alternative to the Original Medicare, including all cardiovascular health benefits covered by Part A and B.

Besides, many Advantage plans offer coverage for prescription medications, such as heart medication. Some plans also provide smoking cessation programs, i.e., programs that help a person quit smoking.

Part D

Part D is also known as prescription drug coverage that anyone with Original Medicare can buy. Each Part D plan comes with the most commonly prescribed drugs, also known as drug formulary, including medications for cardiovascular diseases.

Is Early Detection Covered Under Medicare?

The early detection of any cardiovascular disease is crucial, and Medicare covers a broad range of associated services.

Screening of Cardiovascular Disease

The average person can take a screening test for cholesterol and triglycerides, and lipids in blood every five years. It is also called a full lipid profile. This test is designed to detect conditions that could cause heart attacks or strokes. 

The test is entirely free if the patient visits a Medicare-approved provider.

Cardiovascular Therapy for Behavioral Issues

Individuals can visit their primary physician for cardiovascular behavioral therapy once a year. The therapy involves the following:

  • blood pressure check
  • assessment of the use of aspirin
  • counseling on a healthy diet to people having a high risk of cardiovascular disease.

Similar to the full lipid profile cost, the therapy comes at no cost for those who visit Medicare-approved providers.

Abdominal aorta aneurysm screening

Medicare provides a one-time screening for abdominal aortic aneurysm (AAA). It is a condition of enlargement of the aorta, the main blood vessel that delivers blood to the legs. An individual is eligible for coverage if they are at a risk of an aneurysm. The risk improves due to a history of smoking or someone who had the condition in the family.

The screening is completely free for those who go to a provider that accepts Medicare.

Medicare Out-of-Pocket Costs 

Even though screenings, tests, and hospitalization are covered under Medicare, the medical treatment for cardiovascular diseases may cost you out-of-pocket expenses. 

Here are OOP costs based on different parts of Medicare;

Part A

Part A expenses are for inpatient care. For 2022, these include:

  • $1,556 deductible for each benefit period
  • $0 coinsurance for days 1-60
  • $389 coinsurance per day for 61st-90th day
  • $778 coinsurance per day for lifetime reserve days or more than 90th day

Part B

Part B OOP costs are primarily for outpatient services. For 2022, these include:

  • $170.10 monthly premium
  • $233 annual deductible
  • 20% coinsurance

Parts C and D

Parts C and D expenses include copays, deductibles, the cost of coinsurance, and monthly costs. The costs are different depending on Part C and the Part D plans and vary from one insurance provider to another.

Medicare Programs to Assist With OOP Costs

Medicare provides the below options to help pay the out-of-pocket expenses.

  • Medigap can be described as Medicare supplement insurance that anyone with Medicare could purchase. Medigap plans pay 50 to 90 percent of Parts A and B expenses.
  • Extra Help assists with paying Part D costs for those with low income. It assists with around $5,000 of expenses for medication annually.
  • Medicaid is a federal-state program that assists people who have a low income to cover healthcare costs.
  • Medicare savings programs assist people who have a low income to pay for specific costs.

Summary

Both the Original Medicare and Medicare Advantage cover tests, screenings procedures, and surgeries to treat cardiovascular diseases. If someone has Original Medicare requires coverage for prescription drugs, they can get it through the Part D plan.

Anyone with an Advantage plan requiring prescription drug coverage isn’t qualified to purchase a Part D plan. However, the majority of Advantage plans include this benefit. 

If you need help finding a suitable Medicare plan, our licensed agents specializing in Medicare can assist you. Visit our website for more information.