Medicare & Open-Heart Surgery: What You Need to Know?

Medicare & Open-Heart Surgery: What You Need to Know?

“Does Medicare pay for open-heart surgery?” is a frequently asked question. Heart surgery is covered by Medicare in different ways, including coronary bypass surgery or open-heart surgery, which are used to correct heart valve abnormalities. In addition, a cardiac rehabilitation program, which is meant to strengthen your heart after having heart surgery or suffering from a heart attack, is also covered.

In addition, if your doctor recommends prescriptions for you to take after surgery, your Medicare Part D plan may be able to reimburse you for the costs. To know more, let’s dive into details.

Does Medicare Cover Inpatient Expenses for Open Heart Surgery?

Original Medicare is divided into two components: Hospital Insurance and Medical Insurance. Hospital Insurance is the most expensive of the two portions. Hospital Insurance, often known as Medicare Part A, is a type of health insurance covering inpatient services. 

Open heart surgery is one of the most expensive procedures available, but Medicare pays for medically essential treatments. As a result, Medicare will cover a large portion of the expenses involved with open-heart surgery.

In addition, your Medicare Advantage Plan will also cover a large portion of the costs associated with open-heart surgery, including hospital room and board, nursing care, and any drugs prescribed to you while you are in the hospital.

Does Medicare Cover Open-Heart Surgery Rehabilitation?

If you’ve experienced at least one of the following conditions, Medicare Part B will cover the cost of cardiac rehabilitation. Rehabilitation can be provided for the following reasons;

  • Bypassing the coronary arteries
  • Within the last 12 months, you’ve had a heart attack.
  • Cardiac insufficiency
  • Heart Transplantation
  • Stenting; is a procedure used to treat coronary artery disease.

Medicare Part B will cover 80 percent of the cost, with the remaining 20 percent being your responsibility. As a result, the amount of money you spend out of pocket may be significantly lower if you have a Medigap plan covering Medicare Part B copays and coinsurance. 

If you have Medicare Advantage, your out-of-pocket expenses will be determined by the specifics of your plan. For example, some plans offer cardiac rehabilitation with no fee, while others have more significant copays than those charged by Original Medicare for the service. 

Cardiac rehabilitation involves participating in supervised exercise and counseling to assist you in learning how to maintain a heart-healthy lifestyle after a heart attack or other medical condition.

Medical Insurance Coverage for Medications After Open Heart Surgery

Since Original Medicare does not cover prescription drugs, it will not pay for any medication that your doctor prescribes to take at home after your open-heart surgery. 

However, for those who have a Medicare prescription drug benefit (Medicare Part D), the prescribed drugs, mainly for managing your heart rate, keeping your blood pressure within normal range, and preventing your cholesterol level from rising, may be covered by your Part D coverage. In addition, if you’re a Medicare Advantage enrollee, your plan should cover your post-surgery prescriptions because most Medicare Advantage plans offer prescription coverage.

Does Medicare Cover the Open-Heart Therapeutic Options

In rare circumstances, minimally invasive therapy might be utilized instead of open-heart surgery as a therapeutic option. Angioplasty is one of the most often used therapeutic methods. Angioplasty is a procedure in which a medical balloon is advanced into a clogged artery by a doctor. Increased blood flow is achieved by inflating the balloon, which alleviates the obstruction. 

Stenting is the procedure in which a tube constructed of wire mesh (the stent) is inserted into a clogged artery. The stent maintains the openness, allowing blood to flow freely through it. Both operations are classified as cardiac catheterizations since a catheter is required to move the balloon or stent into the obstructed vascular passageway.

Medicare covers these operations. However, the type of coverage varies depending on the circumstances. For example, if you have an outpatient cardiac catheterization procedure, your Medicare Part B coverage will pay the cost of the operation. However, as long as you are admitted to the hospital for at least two nights, Medicare Part A (Hospital Insurance) will pay the cost of the treatment.

How Much Does Open-Heart Surgery with Medicare Cost?

Your Out-of-pocket (OOP) costs depend on more than having a Medicare Supplement Insurance (Medigap) and how the treatment has been performed, whether inpatient or outpatient.

If services are covered by Medicare Part A, you have to pay a deductible for each benefit period the treatments are provided. 

Each therapy under Medicare Part B is subject to coinsurance and a deductible under the program. 

Your Medicare Advantage expenses will differ depending on your situation. The cost of your drugs will be determined by the formulary followed by the Medicare Part D plan you pick, as Original Medicare does not cover the majority of prescriptions.

If you need to know more about the costs or have any other questions regarding open-heart surgery, you can contact our licensed agents specializing in Medicare. They can also help you if you are looking for a suitable Medicare plan.
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