Does Medicare Cover Heart Bypass Surgery?

Medicare Benefits Solutions
Mar 24, 2021

Medicare provides cardiovascular screening and therapy benefits under Part B to help lower your risk of heart disease. There is no cost on your end for these services if your doctor accepts assignment. When healthcare providers accept assignment, they agree to direct payments from Medicare and do not bill you a higher fee. 

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Medicare Part B Benefits for Cardiac Rehab

Cardiovascular disease screenings entail a blood test every five years to check the levels of cholesterol, triglyceride and lipid in your bloodstream. Abnormal levels point to a high risk of a heart attack or stroke. Cardiovascular disease behavioral therapy is an annual benefit. Services delivered at your doctor’s office include a blood pressure check, nutrition guidance and a conversation about aspirin use if applicable.

Part B benefits include a cardiac rehabilitation program if you have had specific heart issues or coronary bypass surgery. The program encompasses exercise, counseling and education. Your share of the cost is 20% of the Medicare-approved amount when you visit your doctor’s office. If services are rendered in a hospital outpatient facility, a copayment will be due to the hospital. You will also need to meet the Part B deductible, which is $203 in 2021. 

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Medicare Part A Benefits for Inpatient Care

If you need heart bypass surgery, inpatient hospital care is covered under Part A. Original Medicare benefits include the following:

• Semi-private room
• Meals
• General nursing
• Drugs
• Medically necessary hospital services and supplies

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Cardiovascular Screening and Therapy

One of the myths about heart disease is that it only affects seniors. The American Heart Association (AHA) says this is a false assumption. “One in three Americans has cardiovascular disease, but not all of them are senior citizens. Even young and middle-aged people can develop heart problems.” The AHA attributes this to such risk factors as obesity and Type 2 diabetes, variables that have been on the rise in America. 

Coronary bypass surgery is performed on people with blocked arteries at risk of a heart attack or stroke. The Texas Heart Institute reports that “bypass surgery is the most common type of heart surgery with more than 200,000 procedures performed each year in the United States.”  

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Typical Hospital Costs

For the first 60 days as a hospital inpatient, you are responsible for the Part A deductible but no coinsurance. The 2021 Part A deductible is $1,484. While you are an inpatient, you can expect doctor services delivered in the hospital to be covered at 80% of the Medicare-approved amount.  

If you are enrolled in Medigap, note that all or part of the Part A deductible is covered under all Medicare Supplement plans except Plan A. Across all Medigap plans, the Medicare Part A coinsurance and hospital costs are covered at 100% up to an additional 365 days after Medicare benefits have been exhausted.

If you are enrolled in a Medicare Advantage plan, you will have at least the same Part A and Part B benefits as Original Medicare, but many MA plans include additional coverage. These extra benefits may include fitness programs, vision and dental care, and prescription drug coverage.

A new requirement went into effect in 2021 to keep you informed about the cost of hospital items and services. Effective January 1, 2021, hospitals must disclose the amount of standard charges, including charges agreed with MA plans. 

TIP: Find out which plans offer the best benefits for cardiovascular rehabilitation services and compare them against your current coverage.