Fair Square Medicare Wordmark

How Much Does Open Heart Surgery Cost with Medicare?

heart surgery stock image
By Daniel Petkevich
Jan 27, 2023

The right plan could save you thousands of dollars

Heart disease is often linked to risk factors such as high blood pressure, high cholesterol, and smoking — and nearly half of Americans have at least one of these risk factors.

Stay Up to Date on Medicare!

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.
Medical advancements have improved treatment options for heart problems, including medication and lifestyle education, but open heart surgery remains necessary for more complex cases, such as a bypass. It's expensive, however, ranging from $30,000 to $200,000, depending on the specifics.
Luckily for Medicare beneficiaries, heart surgery costs are taken care of. If you're enrolled in a Medicare Supplement Plan G, you could save thousands of dollars on open heart surgery. If you only have Original Medicare, you could receive up to 80% coverage but would be responsible for the remaining 20%.
This article will help you understand what's at stake financially when you're facing the possibility of open heart surgery — and how Medicare helps cover the costs.

What Is Open Heart Surgery?

Open heart surgery is performed to treat a variety of heart ailments. It involves making an incision in the chest to access the heart and its surrounding structures.
The surgery may be done to:
  • Repair or replace damaged or diseased heart valves
  • Repair or remove blockages in the coronary arteries
  • Repair or replace a damaged or diseased heart muscle

When Do You Need Open Heart Surgery

You may need open-heart surgery if you have a heart condition such as:

How Much Does Open Heart Surgery Cost?

The cost of open heart surgery varies depending on the facility, the surgeon and the type of surgery involved.
The most common types of open heart surgery can range from about $30,000 to over $200,000.
Procedures like blockage removal tend to be on the lower end of the cost spectrum, while heart bypass surgery and heart valve replacement typically fall in the middle to higher range. But, a heart transplant is significantly more expensive, costing $800,000 or more.

Does Medicare Cover Open Heart Surgery?

Yes.

Medicare

generally covers open heart surgery or heart bypass surgery when it's medically necessary. This coverage also applies to any additional bypass surgeries, such as a double, triple, or quadruple bypass, as these are all lifesaving procedures.
Let's look at how different the Medicare parts cover open heart surgery.

Medicare Part A Coverage for Open Heart Surgery

Medicare Part A covers the cost of inpatient and hospital care, including heart surgeries.
After paying the Part A deductible of $1,600 (in 2023), Medicare will cover all expenses related to the surgery for the first 60 days of your hospital stay.
If your hospital stay exceeds 60 days, you will be responsible for additional costs as follows:
  • Days 61-90: $400 coinsurance each day 
  • Days 91 and beyond: $800 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to a maximum of 60 reserve days over your lifetime)
  • Each day after the lifetime reserve days: All costs

Medicare Part B Coverage for Open Heart Surgery

Medicare Part B covers outpatient care, including preoperative care and follow-up appointments.
For open heart surgery, Medicare will cover 80% of the approved cost for outpatient care.
However, you’ll be responsible for paying:
  • The Part B annual deductible$226 in 2023
  • 20% of the Medicare-approved costs
Medicare Part B may also cover immunosuppressant drugs.

Medicare Part D Coverage for Open Heart Surgery

Medicare Part D plans help cover

prescription costs

related to open heart surgery, including blood thinners, blood pressure medications, and cholesterol-controlling drugs.
Each plan only covers the drugs listed in its formulary, so check with your plan provider and doctor to determine whether your specific prescriptions are covered. If not, ask your doctor for alternative drugs that are covered by your plan.

Medicare Advantage Plan Coverage for Open Heart Surgery

Medicare Advantage Plans

offer the same coverage as Original Medicare, with some plans providing additional coverage for prescription drugs used to manage heart conditions.
Depending on your plan, you may have a fixed copay or a coinsurance amount that you'll pay until you reach your plan's out-of-pocket limit.
In case of a heart transplant, you may need to obtain prior authorization to get coverage.

Medigap Coverage for Open Heart Surgery

Medigap

or

Medicare Supplement Plans

are insurance policies that supplement Original Medicare coverage and help pay for some out-of-pocket costs, such as deductibles, copays, and coinsurance. Medicare Supplement Plan G limits your out-of-pocket expenses to the Part B deductible of $226, so it's a wise choice to cover major surgery such as this.
Since Original Medicare covers open heart surgery, Medigap plans can help pay for the remaining 20% of costs not covered by Original Medicare, potentially reducing or eliminating your out-of-pocket expenses and preventing a

cost pile-up

.

Cardiac Rehabilitation

Cardiac rehabilitation is a medically supervised program that helps individuals recover from heart disease or heart-related surgery. The program typically includes exercise, education, and counseling to help improve cardiovascular fitness, reduce risk factors for heart disease, and improve overall health and quality of life.
Cardiac rehabilitation may include medication management, stress management techniques, and nutritional counseling.
The goal of cardiac rehabilitation is to help you return to an active and healthy lifestyle after a cardiac event or surgery.

How Long Does Medicare Pay for Cardiac Rehabilitation?

Medicare Part B covers 80% of the costs of a cardiac rehabilitation program if you’ve had at least one of these conditions:
  • A heart attack in the last 12 months
  • Coronary artery bypass surgery
  • Current stable angina (chest pain)
  • A heart valve repair or replacement
  • A coronary angioplasty (a medical procedure used to open a blocked artery) or coronary stent (a procedure used to keep an artery open)
  • A heart or heart-lung transplant
  • Stable chronic heart failure
Medicare Part B also covers intensive cardiac rehabilitation programs in a doctor's office or outpatient setting (including a critical access hospital).
You'll still be responsible for:
  • The Part B annual deductible$226
  • 20% of the Medicare-approved costs (if you receive these services in a doctor's office)
  • A copayment (if you receive these services in a hospital outpatient setting)
Medicare covers cardiac rehabilitation for a maximum of 36 sessions, and if deemed medically necessary, patients may be eligible for additional coverage of 72 sessions, referred to as intensive cardiac rehabilitation.

Medicare Coverage is Complicated, but You Can Get Help

Medicare helps alleviate the cost of open heart surgery by covering both the procedure and the preoperative and post-operative care.
Medicare Part A covers the entire cost of open heart surgery for the first 60 days after the deductible is met. Medicare Part B and Part C help cover the cost of outpatient care and prescription drugs. Medicare Part B also covers your cardiac surgery rehabilitation.
Talk to your insurance provider to learn more about your specific plan coverage and whether your prescriptions are listed in your plan's drug formulary.
If you have any questions about your surgery or Medicare coverage, you can also speak with one of

Fair Square Medicare's advisors

at 1-888-376-2028. We're here to help.

Stay Up to Date on Medicare!

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

Recommended Articles

breast cancer awareness ribbon stock image
Does Medicare Cover Piqray?
Dec 2, 2022
Medicare Part A & Part B stock photo
How Much Does Medicare Part A Cost in 2023?
Nov 18, 2022
COVID-19 at home test stock image
Does Medicare Cover COVID Tests?
Dec 21, 2022
Model of the lungs with the diseased part stock photo
Does Medicare Cover Ofev?
Dec 2, 2022
Cover image
Medicare & Ozempic
Jul 20, 2023
Daniel Petkevich demonstrates Medicare coverage by using a scarf and hat as a metaphor
Medicare 101
May 20, 2020
doctor examining a patient's varicose veins stock photo
Does Medicare Pay for Varicose Vein Treatment?
Nov 18, 2022
Cover image
Does Medicare Cover RSV Vaccines?
Sep 13, 2023
Cover image
How to Become a Medicare Agent
Aug 30, 2023
Cover image
Can Medicare Advantage Plans be Used Out of State?
Jun 12, 2023
Abortion stock image
Does Medicare Cover Abortion Services?
Dec 13, 2022
Cover image
What Is a Medicare Supplement SELECT Plan?
Apr 25, 2023
Teenager Helping his Grandfather at Home stock photo
Does Medicare Cover Geri Chairs?
Dec 7, 2022
Doctor physician consulting with male patients in hospital exam room stock photo
Is PAE Covered by Medicare?
Nov 23, 2022
various cartoon scenarios showing long term care stock photo
Which Medigap Policies Provide Coverage for Long-Term Care?
Sep 16, 2022
Gloved hands with a scalpel begin a knee replacement surgery
Does Medicare Cover Iovera Treatment?
Jan 11, 2023
An illustrated image of a cartoon man using giant scissors to cut the "T" in the word "Tax"
How to Deduct Medicare Expenses from Your Taxes
Dec 28, 2022
Cover image
Health Savings Accounts (HSAs) and Medicare
Jan 24, 2024

More of our articles

13 Best Ways for Seniors to Stay Active in Columbus

13 Best Ways for Seniors to Stay Active in Jacksonville

13 Best Ways for Seniors to Stay Active in Phoenix

14 Best Ways for Seniors to Stay Active in Nashville

14 Best Ways for Seniors to Stay Active in Seattle

14 Best Ways for Seniors to Stay Active in Washington, D.C.

2024 Cost of Living Adjustment

Are Medicare Advantage Plans Bad?

Can I Change My Primary Care Provider with an Advantage Plan?

Can I Choose Marketplace Coverage Instead of Medicare?

Can I Laminate My Medicare Card?

Can I switch From Medicare Advantage to Medigap?

Can I Use Medicare Part D at Any Pharmacy?

Costco Pharmacy Partners with Fair Square

Do All Hospitals Accept Medicare Advantage Plans?

Does Medicare Cover a Spinal Cord Stimulator?

Does Medicare Cover Air Purifiers?

Does Medicare Cover an FMT?

Does Medicare Cover Boniva?

Does Medicare Cover Disposable Underwear?

Does Medicare Cover Driving Evaluations?

Does Medicare Cover ESRD Treatments?

Does Medicare Cover Hearing Aids?

Does Medicare Cover Home Heart Monitors?

Does Medicare Cover Hypnotherapy?

Does Medicare Cover Jakafi?

Does Medicare Cover Ketamine Infusion for Depression?

Does Medicare Cover Krystexxa?

Does Medicare Cover Ozempic?

Does Medicare Cover Penile Implant Surgery?

Does Medicare Cover Physicals & Blood Work?

Does Medicare Cover Scleral Lenses?

Does Medicare Cover Service Animals?

Does Medicare Cover Shock Wave Therapy for Plantar Fasciitis?

Does Medicare Cover SI Joint Fusion?

Does Medicare Cover Stair Lifts?

Does Medicare Cover TENS Units?

Does Medicare Pay for Bunion Surgery?

Does Medicare pay for Opdivo?

Everything About Your Medicare Card + Medicare Number

Finding the Best Dental Plans for Seniors

How Do Medigap Premiums Vary?

How is Medicare Changing in 2023?

How Much Does Medicare Cost?

How Much Does Medicare Part B Cost in 2023?

How Much Does Open Heart Surgery Cost with Medicare?

How Much Does Trelegy Cost with Medicare?

How Much Does Xeljanz Cost with Medicare?

How to Enroll in Social Security

Is Botox Covered by Medicare?

Is Emsella Covered by Medicare?

Is the Shingles Vaccine Covered by Medicare?

Is Vitrectomy Surgery Covered by Medicare?

Medicare Advantage MSA Plans

Medicare Advantage Plans for Disabled People Under 65

Medicare Consulting Services

Medicare Deductibles Resetting in 2024

Medicare Guaranteed Issue Rights by State

Medicare Savings Programs in Kansas

Saving Money with Alternative Pharmacies & Discount Programs

Should You Work With A Remote Medicare Agent?

The Fair Square Bulletin: August 2023

The Fair Square Bulletin: February 2024

The Fair Square Bulletin: January 2024

The Fair Square Bulletin: July 2023

The Fair Square Bulletin: October 2023

What Does Medicare Cover for Stroke Patients?

What is the 8-Minute Rule on Medicare?

What's the Deal with Flex Cards?

When to Choose Medicare Advantage over Medicare Supplement

Why Is Medicare So Confusing?

Why You Should Keep Your Medigap Plan

Your Medicare One-Stop-Shop

Your guide to Medicare Parts A & B, Medicare Advantage, and Medigap. 100% free.
Get the Fair Square Bulletin

Medicare savings tips, helpful guides, and more.

About

Medicare 101

Current Clients

Medicare Supplement Plans

Medicare Advantage Plans

Fair Square 2024

Terms of Use
Notice of Privacy Practices

Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2024 Help Button Inc

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

MULTIPLAN_FairSquareMedicare_01062022_M