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What Does Medicare Cover?

Medicare is the federal health insurance program designed for people in the US who are age 65 or older. It is available to a small group of younger people – those who have disabilities and those with End-Stage Renal Disease.

Parts of Medicare

Medicare has 3 general parts which cover specific types of services.1

Medicare Part A

is hospital insurance. It covers inpatient hospital stays, healthcare in a skilled nursing facility, hospice care, and some home services.

Medicare Part B

is medical insurance. It covers most physician services, outpatient care, medical supplies, and preventive care.

Medicare Part D

is prescription drug coverage. Drug plans come in different levels and costs will vary depending on the type of plan you select, the drugs used, whether the pharmacy is in-network, and whether the drugs are in the plan formulary.

Medicare coverage is based on federal and state laws. It pays for preventive and medically necessary services that are required to diagnose or treat your medical condition. That does not mean it covers all services. Costs and services that Medicare does not cover may be covered by a supplemental insurance plan. If you are enrolled in Medicare Parts A and B you can purchase a Medicare supplement. This is a private insurance policy that you can purchase to defray some of the costs not covered by Medicare. This can include deductibles and copayments, even picking up all or a portion of your co-insurance.

The Centers for Medicare & Medicaid Services’ Center for Consumer Information and Insurance Oversight (CCIIO) provides comprehensive information on available coverage options. They can help to answer questions about the Medicare program. Specific questions regarding individual services can be directed to the Medicare Service Center: 1-800-MEDICARE (800-633-4227). If you have a supplemental plan you can contact them for additional information as well.

Heart failure coverage

If you have heart failure (HF) you may need a number of tests, services, medications and perhaps implantable devices. As long as you seek care from Medicare providers some coverage examples include:

Medications

Medicationis essential to the management of heart failure. They help people live longer, healthier lives. Drugs can be very expensive but adhering to the treatment plan can help reduce other costs. Each year you have the ability to make changes to your plan coverage. Make sure you have a list of all your medications and ask your provider about any new medications that they may prescribe to ensure that they are covered on the plan you select. Be sure to select the appropriate plan for your health care and medication needs.1

Implantable devices

Implantable devices like pacemakers or ICDs are covered if you have been diagnosed with heart failure. Medicare Part A is responsible if the surgery takes place in a hospital inpatient setting. Medicare Part B is responsible if the surgery takes place in a hospital outpatient setting.

Cardiac rehabilitation programs

Cardiac rehab is covered by Medicare Part B. You may be eligible if you have had a heart attack in the last 12 months, coronary artery bypass surgery, heart valve repair or replacement, a transplant, or chronic heart failure among several other conditions. These programs generally include exercise, education, and counseling.1

Organ transplants

Medicare A and B both cover services for heart transplants. Services include lab tests, imaging tests, medical visits, surgery, organ procurement, immunosuppressive drugs, and follow-up care. Transplants need to be performed in a Medicare-approved facility to qualify for coverage.

Other covered procedures

Other covered Medicare procedures include coronary angiography, CT and MRI scans, insertion of electrodes and catheters, nuclear medicine studies of coronary structures and dozens of others as determined to be medically necessary based on your medical diagnosis.1 There are some limits to the frequency of certain tests with regard to reimbursement. Always check with your doctor or call Medicare to understand your personal benefits.

Written by: Linda Minton | Last reviewed: November 2019
  1. What Medicare Covers. Medicare. Available at: https://www.medicare.gov/what-medicare-covers. Accessed 10/27/19.
  2. The Center for Consumer Information & Insurance Oversight. Centers for Medicare and Medicaid Services. Available at: https://www.cms.gov/CCIIO/Resources/About-Us/index.html. Accessed 10/27/19.