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Medicare on Heart Disease Screening

Heart disease, describes a range of conditions that affect your heart. Diseases under the heart disease umbrella include blood vessel diseases, such as coronary artery disease; heart rhythm problems (arrhythmias); and heart defects you're born with (congenital heart defects), among others.

This is often used interchangeably with the term cardiovascular disease. Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. Other heart conditions, such as those that affect your heart's muscle, valves, or rhythm, also are considered forms of heart disease. Screening blood tests for cholesterol, lipid, and triglyceride levels can detect conditions that may lead to heart disease.

Eligibility

Medicare Part B covers blood tests for heart disease once every five years when ordered by your provider. You do not need to show signs of heart disease or have any particular risk factors to qualify for these tests.

Costs

If you are eligible, Original Medicare will cover screening blood tests for heart disease at 100% of the Medicare-approved amount when you receive the service from a participating provider. This means you will pay nothing for the said service.  

Medicare Advantage Plans are required to cover heart disease screenings without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.

During the course of your heart disease screening, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, which means your provider is treating you because of certain symptoms or risk factors. This time, Medicare may bill you for any diagnostic care you receive during a preventive visit.

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