Heart disease is the leading cause of death for men and women in the United States. The Centers for Disease Control and Prevention estimate that heart disease kills 659,000 Americans each year, and about half of U.S. adults have at least one major risk factor for heart disease.
Caring for your cardiovascular health and managing chronic conditions like high blood pressure is important. A cardiologist can help.
Let’s see which cardiology services are covered by Medicare.
Are cardiologists covered by Medicare?
We are often asked, “Does Medicare cover cardiologist visits?” Yes, Medicare covers cardiologists as long as they provide medically reasonable and necessary services.
Cardiology services covered by Medicare fall under Part A (hospital insurance) or Part B (medical insurance).
Part A coverage
Part A covers hospitalization for heart surgery or following a heart attack, stroke or other cardiac issues.
Your out-of-pocket costs per benefit period for inpatient hospital care under Part A are:
- $1,556 deductible
- Days 1-60: $0 coinsurance
- Days 61-90: $389 coinsurance per day
- Days 91 and beyond: $778 coinsurance per each lifetime reserve day after day 90. (You have up to 60 lifetime reserve days)
- Beyond lifetime reserve days: All costs
Part B coverage
Medicare Part B covers cardiology services provided in an outpatient setting.
The annual Part B deductible is $233. After meeting the deductible, you typically pay 20 percent of the Medicare-Approved Amount for most doctor services.
Screenings
Part B covers cardiovascular disease screenings once every 5 years at no cost to you. These screenings include blood tests for cholesterol, lipids and triglycerides.
Cardiovascular behavioral therapy
Part B covers cardiovascular behavioral therapy once a year with your doctor free of charge. During the visit, your doctor will check your blood pressure, share tips on healthy eating and may discuss aspirin use.
Cardiac rehabilitation
If you’ve had a heart attack or have heart failure or other cardiac problems, a doctor may prescribe exercise, education and counseling as part of a cardiac rehabilitation program.
Part B covers intensive or regular cardiac rehabilitation if you’ve had one of the following:
- A heart attack in the last 12 months
- Coronary artery bypass surgery
- Current stable angina (chest pain)
- Heart valve repair or replacement
- Coronary angioplasty or coronary stent
- Heart or heart-lung transplant
- Stable chronic heart failure
A copayment applies if you get rehabilitation services in a hospital outpatient setting.
Abdominal aortic aneurysm screening
Part B covers one abdominal aortic ultrasound in a lifetime for patients with the following risk factors:
- Family history of abdominal aortic aneurysms
- Men ages 65 to 75 who have smoked at least 100 cigarettes
There is no charge for the screening when your doctor accepts assignment. You must have a referral to be screened.
Do all cardiologists accept Medicare?
Most doctors, including cardiologists, accept Medicare. But a doctor can choose to opt out of the federal health insurance program for seniors. When that happens, the doctor is not bound by Medicare’s cost limits and you’ll be responsible for paying the full amount of any service.
Does Medicare cover a cardiac stress test?
A cardiac stress test involves monitoring a patient’s heart function during exercise or, when that’s not possible, by simulating the effects of exercise with medication.
Medicare covers cardiac stress tests when the test is medically reasonable and necessary. This includes patients who:
- Have signs or symptoms of coronary artery disease.
- Have a disorder, such as diabetes, that can cause coronary artery disease.
- Have an abnormal electrocardiogram consistent with coronary artery disease.
Medicare does not cover cardiac stress testing when:
- A patient doesn’t have signs or symptoms of coronary artery disease.
- The information from a repeat test is not clinically relevant.
- The results of the test won’t affect treatment.
- The test is performed too frequently.
- A secondary condition will decrease the usefulness of the test.
Medicare will cover a stress echocardiogram and radionuclide imaging, in addition to a cardiac stress test, when medically reasonable and necessary.
Can a primary care doctor help me find a Medicare cardiologist?
Primary care doctors help their patients manage their health, including chronic cardiovascular diseases. When you need more specialized heart care, your primary care doctor can help you connect with a Medicare cardiologist near you.
Where can I find a primary care physician who accepts Medicare patients?
NewPrimaryCare.com™ can help you find a quality primary care doctor near you. Our partner providers practice value-based care, meaning Medicare rewards them for helping patients live healthier rather than the number of patients they treat.
A value-based care doctor will take the time to get to know you and your unique needs. You can expect quicker appointment scheduling, shorter waits at the doctor’s office and a meaningful connection with your physician.
Use our Find Your Doctor tool to search for and compare value-based care providers near you.
