Does Medicare Cover Open Heart Surgery?

In this article...
  • Does Medicare cover open heart surgery? It depends on which type of Medicare you have. Keep reading to learn more about Medicare coverage for heart procedures.

"Does Medicare cover open heart surgery?" is a common question. Medicare covers several types of heart surgery, including coronary bypass and open heart surgery used to treat problems with the heart valves. It also covers cardiac rehabilitation, a program designed to strengthen your heart after heart surgery or a heart attack. If your doctor prescribes medications to take following your surgery, your Medicare Part D plan may cover the costs.

Does Medicare Cover Open Heart Surgery Inpatient Expenses?

Original Medicare is broken into two parts: Hospital Insurance and Medical Insurance. Hospital Insurance, also called Medicare Part A, covers the services you receive as an inpatient in a hospital. Although your plan may not mention open heart surgery specifically, this type of surgery is "medically necessary." Medicare pays for medically necessary services, or services used to diagnose or treat illnesses and injuries, so it will cover many of the costs associated with open heart surgery. 

Medicare Advantage must cover everything covered by Original Medicare, so you get the same inpatient benefits as a Medicare Advantage enrollee as you would if you signed up for Original Medicare. Therefore, your Medicare Advantage Plan will also cover many of the costs of having open heart surgery, including hospital room and board, nursing care and any medications given to you while you're in the hospital.

Does Medicare Cover Open Heart Surgery Rehabilitation?

Medicare will pay for cardiac rehabilitation if you've had at least one of the following:

  • Coronary artery bypass
  • Heart attack within the past 12 months
  • Heart failure
  • Heart transplant
  • Stable angina
  • Coronary angioplasty or stenting
  • Heart valve replacement or repair

If you have Original Medicare, your Part B benefits may pay for 36 rehabilitation sessions. Once you pay your Part B deductible, Medicare Part B pays for 80% of the cost, leaving you to pay the other 20%. Your out-of-pocket costs may be even lower if you have a Medigap plan that covers Medicare Part B copays and coinsurance. If you have Medicare Advantage, your out-of-pocket costs will depend on your plan details. Some plans cover cardiac rehabilitation with no copay while other plans have higher copays than Original Medicare. During cardiac rehabilitation, you'll participate in supervised exercise and counseling to help you understand how to live a heart-healthy lifestyle.

Medicare Coverage for Medications After Open Heart Surgery

Original Medicare doesn't cover most prescriptions, so it won't pay for medications that your doctor prescribes for you to take at home following your open heart surgery. If you have a Medicare drug supplement (Medicare Part D), however, your Part D benefits may cover medications used to control your heart rate, keep your blood pressure within the normal range and prevent your cholesterol level from increasing. Most Medicare Advantage Plans include some type of prescription coverage, so if you're a Medicare Advantage enrollee, your plan should cover your post-surgery medications.

Medicare Coverage for Heart Valve Surgery

Although open heart surgery is often performed to treat coronary artery disease, it's also used to repair or replace damaged heart valves. If the surgery is medically necessary, your Medicare Part A benefits will cover much of the cost.

Medicare Coverage for Angioplasty and Stenting

In some cases, minimally invasive treatment is used as an alternative to open heart surgery. Angioplasty and stenting are two of the most common treatment options. During an angioplasty, a doctor advances a medical balloon into a blocked artery. Inflating the balloon relieves the blockage, resulting in improved blood flow. Stenting involves inserting a tube made of wire mesh (stent) into the blocked artery. The stent holds the artery open, letting blood flow through it unobstructed. Both procedures are considered cardiac catheterizations because a catheter is needed to advance the balloon or stent into the blocked vessel.

Medicare covers these procedures, but the type of coverage depends on the circumstances. If you have a cardiac catheterization on an outpatient basis, your Medicare Part B benefits will cover the procedure. Medicare Part A (Hospital Insurance) will cover the procedure if you're admitted to the hospital for at least two nights.

How Much Does Open Heart Surgery Cost With Medicare?

Your out-of-pocket costs depend on several factors, including the type of Medicare you have, whether you have a Medicare Supplement Insurance (Medigap) plan and whether you have the procedure on an inpatient or outpatient basis. If the services are covered under Medicare Part A, you'll need to pay a deductible for each benefit period. Medicare Part B also has a deductible, along with a copay or coinsurance for each service. If you're enrolled in Medicare Advantage, your costs will vary based on where you live and which plan you select. Because Original Medicare doesn't cover most prescriptions, the cost of your medications will depend on which Medicare Part D supplement you choose.