What Medicare Members Need to Know About Heart Disease Coverage

Living with Hypertension

More than 121 million adults in the U.S. live with some form of heart disease, according to the American Heart Association (AHA). Also known as cardiovascular disease (CVD), heart disease includes a variety of conditions that can lead to serious issues like heart attacks or strokes.

These conditions include:

Coronary artery disease
Irregular heartbeat
Heart valve issues
Problems with heart muscle
Hereditary (congenital) defects

Older adults face a higher risk of heart disease due to age-related factors such as changes in heart function, lower hormone levels, and conditions like obesity and diabetes. However, the good news is that early detection makes heart disease much easier to manage. Regular cardiovascular screenings, along with adopting heart-healthy habits like exercise and a proper diet, can significantly reduce your risk.

Does Medicare Cover Heart Disease?

Yes! Medicare covers a variety of heart disease-related screenings, services, and treatments. However, coverage specifics may vary depending on your plan, so it’s important to review your Medicare coverage before scheduling an appointment. Below, we answer some common questions about heart disease and Medicare.

What is Cardiovascular Screening?

A cardiovascular screening typically includes blood tests to check cholesterol, lipid, and triglyceride levels—factors that affect coronary artery health. During a cardiovascular risk reduction visit, your doctor will also measure your blood pressure and provide advice on preventing heart disease.

Does Medicare Cover Cardiovascular Screenings?

Yes. Original Medicare Part B covers cardiovascular screening blood tests once every five years at no cost, as long as you see a participating provider. Medicare Advantage plans must also fully cover these screenings when performed by in-network providers. However, if additional concerns arise during your screening, you may be responsible for out-of-pocket costs for further tests.

Does Medicare Cover Cardiovascular Risk Reduction Visits?

Yes. Medicare Part B covers one cardiovascular risk reduction visit per year. You do not need to show signs of heart disease to receive this benefit. Medicare Advantage plans also cover these visits annually with in-network providers.

Does Medicare Cover Cardiologist Visit?

Yes, but it depends on the provider. Medicare Part B covers outpatient cardiology visits once you meet your deductible. However, not all providers accept Medicare’s approved amount as full payment:


Participating providers	Accept Medicare’s payment in full, but you may still owe coinsurance.

Non-participating providers:	May charge you up to 15% more than what Medicare pays.

Opt-out providers	Do not accept Medicare at all, so you would be responsible for the full cost of care.

Always ask your cardiologist whether they accept Medicare before scheduling an appointment to avoid unexpected costs.

Does Medicare Cover Chronic Heart Disease?

Yes. If you have two or more chronic conditions (lasting 12 months or more), Medicare Part B covers care management services to help you better manage them. Heart disease, diabetes, asthma, and arthritis are among the conditions eligible for this service. Keep in mind that you may still need to pay deductibles, copayments, and coinsurance.

Next Steps

If you are experiencing symptoms of heart disease or want to take preventive steps, speak to your healthcare provider about scheduling a cardiovascular screening or risk reduction visit. Early detection and management can greatly improve your quality of life and reduce medical expenses.

For more information, visit Medicare.gov or contact the Medicare Helpline at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048

Take care of your heart, and it will take care of you.

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