Insurance Status Among Those With Heart Failure

In recent years, health insurance and the cost of healthcare have become issues of regular debate.

Our 2020 Heart Failure In America survey looked at the health insurance status of men and women living with heart failure and how their insurance has impacted their care. More than 600 people with heart failure completed the survey and provided more information about the insurance landscape.

What are the most common types of insurance?

The main sources of insurance in the United States are Medicare, Medicaid, and private insurers.

• Medicare: Covers those who are permanently disabled or those who are over 65 years old. Although Medicare covers many aspects of healthcare, some individuals need to add secondary insurance outside of Medicare to help them completely cover their bills.
• Medicaid: Provides insurance to those who have a limited income.
• Private insurance: Can be individually purchased through the Health Insurance Marketplace or can be sponsored by an employer (often called group insurance).
• Self-pay: Those who are uninsured or underinsured must pay their healthcare bills out of pocket. Some healthcare facilities will offer lower service prices to those who are completely self-paying.

Primary health insurance for heart failure patients

The majority of survey respondents have Medicare as their primary health insurance. Respondents shared that their primary health insurance coverage is as follows:

• 63 percent have Medicare
• 15 percent have group insurance through their employer or the employer of a spouse or family member
• 6 percent have Medicaid
• 4 percent have coverage through the health insurance exchange of the Affordable Care Act
• 3 percent have private insurance purchased directly from the insurance company
• 3 percent have military coverage through the Department of Defense (VA or TRICARE)
• 2 percent have other insurance or are not sure of what type
• 3 percent do not have primary health insurance

Secondary health insurance for heart failure patients

A large percentage of respondents (73 percent) who have health insurance reported that they also have secondary or supplemental coverage. Only 27 percent of respondents do not have this type of insurance coverage.

The most common types of secondary or supplemental coverage are as follows:

• 47 percent have Medicare supplemental health insurance coverage
• 33 percent have Medicare Part D (Medicare prescription drug benefit)
• 15 percent have private/group supplemental health insurance coverage
• 13 percent have prescription drug coverage that is separate from their health insurance coverage

How is health insurance related to heart failure?

Cardiovascular conditions like heart failure and heart attacks are often evaluated over time. In primary care settings (or general family practice offices), risk factors for these cardiovascular conditions are assessed. A primary care doctor can perform routine screening for these conditions and recommend tests or medications to reduce a person’s risk of developing a life-altering condition like heart failure.

If a person is already showing signs of heart failure or another cardiovascular condition, their primary care doctor can refer them for testing to diagnose the condition. A primary care doctor can also send a person to a specialist, like a cardiologist, for more testing.

When a person does not have health insurance or has health insurance that does not completely cover their needs (called being underinsured), they are often unable to regularly see a doctor. This includes both for sick visits and for regular well-visits to undergo screening for heart conditions, as well as to start medications that can prevent heart issues. Without these visits, people who are insured or underinsured may not be diagnosed with heart failure until the condition is far progressed or they are sick enough to be in the hospital.

A lack of insurance has been linked to worse outcomes in the hospital, poorer quality of care, and worse short-term outcomes for people with heart failure. While data on long-term outcomes related to insurance status is limited, it does seem like in the short-term, being properly insured can make a big difference. The Affordable Care Act helped millions of individuals, especially those with lower income, get insured. This helped improve access to primary care, specialty care, and prescription medications to prevent or treat heart failure.¹

The Heart Failure In America 2020 survey was conducted online from October 2019 through April of 2020. 642 people completed the survey.