Open heart surgery is a complex and delicate medical procedure that involves the repair or replacement of a damaged heart valve, the treatment of congenital heart defects, or the bypass of blocked arteries. If you or someone you know requires open heart surgery, you may be wondering if Medicare will cover the cost of the procedure.
In this blog post, we will explore whether Medicare covers open heart surgery and what your healthcare options are.
What is Open Heart Surgery?
Open heart surgery is a surgical procedure that involves opening the chest to access the heart. During the surgery, the heart is temporarily stopped, and a heart-lung machine is used to pump oxygen-rich blood to the body. The surgeon can then perform the necessary repairs or replacements on the heart before closing the chest. Open heart surgery is a major procedure that requires a hospital stay and a significant recovery period.
What Does Open Heart Surgery Cost Without Insurance?
Without insurance, open heart surgery can be expensive, and the cost can vary depending on the complexity of the procedure and the hospital’s location. According to a report by Healthcare Bluebook, the average cost of open heart surgery in the United States is around $324,000. This cost includes the hospital stay, surgeon fees, anesthesia, and other related expenses. The cost can be higher if there are complications or if the surgery requires an extended hospital stay.
Does Medicare A and B Cover Open Heart Surgery?
Medicare Part A covers hospital inpatient care, which includes open heart surgery. With Part A, you’ll pay a per-occurrence Part A deductible and will be responsible for a per-day copay if your hospital stay is more than 60 days. Part A also covers post-surgery care, such as medications, supplies, and rehabilitation. Part B covers medically necessary services and supplies, including doctor visits, outpatient care, and diagnostic tests related to your open heart surgery. For Part B, Medicare typically pays 80% of the cost and you are responsible for 20% of the cost.
If you have a Medicare Supplement plan, your supplement plan may help cover the out of pocket coinsurances or copayments you may owe under Medicare A and B.
Does Medicare Advantage (Part C) Cover Open Heart Surgery?
Medicare Advantage, also known as Part C, is an alternative to traditional Medicare. Medicare Advantage plans are offered by private insurance companies and include all the benefits of Medicare A and B, and often include additional benefits such as vision, dental, and prescription drug coverage. If you have a Medicare Advantage plan, your cost for open heart surgery will vary based on the plan you choose.
Medicare Advantage plans are required to cover at least the same services covered by Medicare A and B. In other words, any procedures deemed medically necessary will be covered, however, copays or coinsurances for surgery may vary significantly between plans.
Does Medicare Cover Any Minimally Invasive Alternatives to Open Heart Surgery?
There are several minimally invasive alternatives to open heart surgery, including transcatheter aortic valve replacement (TAVR) and percutaneous coronary intervention (PCI). TAVR is a procedure that involves inserting a new valve through a small incision in the leg or chest, and PCI involves inserting a small tube (catheter) into a blocked artery to restore blood flow. Medicare covers these procedures if they are medically necessary, and your doctor determines that they are appropriate for you.
Does Medicare Pay for Cardiac Rehabilitation After You Have Open Heart Surgery?
Yes, Medicare covers cardiac rehabilitation after you have open heart surgery. Cardiac rehabilitation is a medically supervised program that includes exercise, education, and counseling to help you recover from your surgery and improve your overall heart health. Medicare covers up to 36 sessions of cardiac rehabilitation over a period of 36 weeks.
Conclusion
Open heart surgery is a major medical procedure that can be expensive without insurance. Fortunately, Medicare covers the cost of open heart surgery and related services, including hospital stays, doctor visits, and cardiac rehabilitation. If you have Medicare Advantage, your coverage may vary depending on the plan you choose.
If you have questions around Medicare and what coverage is available for important procedures such as open heart surgery, reach out to CoverRight today.
