What Medicare Does and Does Not Cover for Your Heart

Heart disease remains the number one killer of Americans. According to the Centers for Disease Control and Prevention (CDC), one in four deaths is attributed to some form of cardiovascular disease.

As many as 735,000 people have a heart attack and 795,000 people have a stroke every year.

Cardiovascular disease, left untreated, can lead to serious debilitation and even death. That not only costs you in health, but it costs you in dollars. A study by the CDC Foundation estimated that direct medical costs for heart disease could reach $818 billion annually by 2030. When you add lost productivity to the mix, that amount could rise to over $1 trillion per year.

It is more important than ever to take steps to prevent these diseases whenever possible. Eating right, exercising regularly, and quitting smoking can help, but sometimes our genes run the show. Preventive screening and early treatment can help to decrease complications from these diseases, perhaps even cure them. For these reasons, Medicare covers the following tests and treatments, many of them for free but some only under certain circumstances.

1
Medicare and Aneurysm Screening

Abdominal Aortic Aneurysm
ZEPHYR / Science Photo Library / Getty Images

Aneurysms are thinned out areas in your arteries that cause them to weaken and widen. Whether these aneurysms occur in the brain, heart, or abdomen, they can be especially dangerous if they rupture. A tear in the aorta, the blood vessel that carries blood from the heart to the body, can result in massive internal bleeding and immediate death.

Medicare pays for free screening of abdominal aortic aneurysms, as long as your doctor is a participating provider. The screening is only covered if certain conditions are met. Specifically, you must have a family history of an aortic aneurysm or you must be a man between the ages of 65 and 75 years old who has smoked 100 or more cigarettes in his lifetime. A female smoker, even if she smokes more than her male counterpart, is not eligible for free aneurysm screening unless she has a family history.

This evaluation is done with a simple non-invasive ultrasound and is offered only once under Medicare.

You could develop an abdominal aneurysm later in life, but Medicare is not going to pay to look for one again, not unless you develop symptoms.

Take note that Medicare does not offer free screening for aneurysms in other parts of the body (i.e., in the brain) even if there is a known family history.

2
Medicare and Blood Pressure Screening

blood pressuring screening hypertension
PhotoAlto/Eric Audras / PhotoAlto Agency RF Collections / Getty Images

One in three Americans has high blood pressure, according to the CDC. Unfortunately, hypertension is the single greatest risk factor for heart attack and stroke. That puts a large segment of the U.S. population at risk.

There are different stages of hypertension. The top blood number is your systolic blood pressure, the lower number your diastolic pressure. The higher your stage, the greater your risk.

  • Normal: Less than 120 / 80
  • Pre-hypertension: 120 to 139 / 80 to 89 
  • Stage 1 hypertension: 140 to 159 / 90 to 99 
  • Stage 2 hypertension: Greater than 160 / 100

You are staged based on the higher reading for either systolic or diastolic blood pressure. For example, if your blood pressure is 135/90, you are stage 1 even though your systolic blood pressure is pre-hypertensive.

Unfortunately, hypertension is a "silent killer." The majority of people who have it do not feel sick from it. Without proper screening, they do not know they are at risk, they do not know to make changes in their lifestyle, and they are not started on medication, if needed.

Blood pressure screening and counseling are free as part of your Welcome to Medicare and Annual Wellness Visits. That said, blood pressure screening is often routinely included in your office visits too. Your doctor is unlikely to charge you for screening.

You may choose to monitor your blood pressure on your own as well. Pharmacies often have a free blood pressure machine for you to use or you can purchase your own blood pressure cuff. 

3
Medicare and Cholesterol Screening

clogged arteries and plaque
jamesbenet / E+ / Getty Images

Cholesterol often gets a bad rap, but we could not live without it. It forms the membranes for every cell in the body, and it is used to produce aldosterone that regulates salt and water balance; bile that helps you digest fatty food; cortisol that manages your blood sugar, boosts your immune system, and helps you cope with stress; hormones like estrogen, progesterone, and testosterone that establish your sexual characteristics; and vitamin D that supports bone health.

The problem is that too much cholesterol can increase your risk for cardiovascular disease, at least when it builds up in the arteries. This excess cholesterol can lead to the formation of plaque, thickened material, that can obstruct blood flow through the arteries or that can break off into clots, eventually blocking smaller blood vessels downstream. Either way, blood supply to the brain or heart could be compromised, leading to a heart attack or stroke.

Managing high cholesterol is key to decreasing your risk for heart disease.

This is why Medicare covers cholesterol screening free of charge once every five years. Keep in mind any additional screenings will come out of your own pocket.

This does not mean that Medicare won't pay for cholesterol testing more often. It is only that it won't be free. If you have coronary artery disease, high cholesterol, or other risk factors for heart disease, your doctor may order routine blood work as often as twice a year. In this case, you will pay a 20 percent coinsurance for each test.

4
Medicare and Heart Disease Screening

heart attack
PIXOLOGICSTUDIO / Science Photo Library / Getty Images

This year, 525,000 Americans will experience their first heart attack and 210,000 who have already had one in their lifetime will have another one. Of those 735,000 people, 370,000 will die.

Heart disease is all too common in the United States. Some of our risk factors for coronary artery disease are unavoidable—age (65 years or older), gender (male), and race (American Indians, Alaskan Natives, and Pacific Islanders are at higher risk). Other risk factors are, to an extent, under our control.

Of these modifiable risk factors, the CDC reports that nearly half of Americans have at least one of the three major risk factors for heart disease.*

If you have two or more of these risk factors, you may be concerned about your risk for a heart attack.

Cardiac stress testing is one way to screen for heart disease. In these evaluations, your heart is monitored as you run or walk on a treadmill or if you are physically unable to do so, a medication is administered to simulate how your heart would respond to exercise. Changes to your heart before and after exercise can be a sign that there are blockages in the arteries that feed your heart.

The heart is then examined by way of an electrocardiogram (EKG), echocardiogram (ultrasound of the heart), or nuclear imaging where pictures of your heart are taken after you are injected with a radioactive tracer. 

An abnormal stress test requires follow-up with more definitive testing,  a cardiac catheterization. This test is performed by a cardiologist who inserts a catheter into a major vein and guides it into your heart. A dye is then released into the heart to look for narrowing of the coronary arteries. A stent can even be placed during the catheterization procedure to open up and treat certain types of blockages.

Without symptoms, Medicare is not going to pay for a cardiac stress test. Simply put, these tests are not done for screening purposes.

Medicare does cover cardiac stress testing and cardiac catheterization for people who have known heart disease and for people with suspected heart disease based on symptoms (chest pain, shortness of breath, etc.). These tests are covered under Part B, leaving you to pay a 20 percent coinsurance.

A Word From Verywell

The risk for heart disease increases as we age, regardless of gender or race. For that reason, it is no surprise that Medicare, the largest insurer of American seniors, includes coverage for prevention and screening of heart disease. Early intervention allows your doctor to educate you about lifestyle modifications and to treat you with medications, hopefully before complications like heart attack and stroke develop. Aneurysm screening, high blood pressure screening, cholesterol screening, and cardiac stress tests are all on the Medicare fee schedule, but that does not mean they are covered every time. Understand what Medicare does and does not cover and when they cover it, so that you are not caught by an unexpected bill.

Sources:

Heart Disease And Stroke Cost America Nearly $1 Billion A Day In Medical Costs, Lost Productivity. CDC Foundation website. https://www.cdcfoundation.org/pr/2015/heart-disease-and-stroke-cost-america-nearly-1-billion-day-medical-costs-lost-productivity. Published April 29, 2015.

Heart Disease Facts. Centers for Disease Control and Prevention website. https://www.cdc.gov/heartdisease/facts.htm. Updated August 24, 2017.

High Blood Pressure Facts. Centers for Disease Control and Prevention website. https://www.cdc.gov/bloodpressure/facts.htm. Updated November 30, 2016.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA. 2003 May 21; 289(19): 2560-72.  doi:10.1001/jama.289.19.2573

Stroke Facts. Centers for Disease Control and Prevention website. https://www.cdc.gov/stroke/facts.htm. Updated September 6, 2017.

Continue Reading