Heart Disease and Medicare
- Last updated
- October 11, 2026
- Read time
- 5 min
Key points
- Heart and blood vessel disease caused 1 in 3 U.S. deaths in 2023, the Centers for Disease Control and Prevention says.
- In 2026, you pay 20% after the $283 deductible for up to 36 cardiac rehab sessions, or 72 intensive ones.
- Only 19% to 34% of people who could use cardiac rehab took part in a 2016 national study, Million Hearts says.
- Since January 1, 2026, Medicare has set lower prices for Eliquis, Xarelto, Entresto and Farxiga, Medicare says.
Medicare pays for heart care in the hospital and after you get home. It covers heart doctor visits, tests, surgery, cardiac rehab and your heart medicines. You usually pay 20% for doctor care and rehab. If you just came home with a new diagnosis and new pills, the first weeks can feel like a lot.
Medicare pays for heart care if
- You have Part B, the part of Medicare that pays for doctor visits, tests and rehab.
- Your doctor orders the test or refers you to cardiac rehab.
- You have a Medicare drug plan, or a Medicare Advantage plan with drug coverage, for your pills.
Not sure Medicare will pay? Ask anyway, because your heart doctor's office can check first. Or a Pair Team advocate can check with you.
What Medicare pays for (2026)
| Service | Who it is for | What you pay |
|---|---|---|
| Cardiac rehab | A heart attack in the last 12 months, bypass surgery, stable chest pain (angina), a valve repair or replacement, a stent or angioplasty, a heart transplant, or stable heart failure | 20% after the $283 deductible, plus a copay at a hospital clinic |
| Intensive cardiac rehab | The same heart problems, at a Medicare-approved program | The same as cardiac rehab |
| Heart tests | An electrocardiogram (EKG), echo or stress test your doctor orders | 20% after the deductible, plus a hospital copay at a hospital |
| Heart doctor visits | Anyone with Part B | 20% after the deductible |
| Hospital stay (Part A) | When you're admitted | $1,736 for each benefit period |
| Care management | 2 or more long-term problems, or 1 serious one | 20% after the deductible, each month |
| Heart drugs (Part D) | Anyone with a Medicare drug plan | No more than $2,100 a year for covered drugs |
| ACCESS | Original Medicare and heart disease from narrowed arteries | Most groups charge $0 to $7 a month |
Does Medicare pay for cardiac rehab?
Yes, Medicare pays for cardiac rehab if you've had one of the heart problems in the table. Rehab is exercise with a care team watching, plus help with food, stress and medicines. Regular rehab is up to 36 one-hour sessions over 36 weeks, and Medicare can approve 36 more. Intensive rehab is up to 72 sessions over 18 weeks, federal rules say.
You pay 20% for each session, so 36 sessions add up. A Medigap plan, or Medicaid if your income is low, can pay that share. See Medicare Savings Programs.
How does coverage change with your type of heart disease?
Your type of heart disease changes which rehab and newer programs you can use.
If your arteries are blocked or narrowed, you qualify for rehab after a heart attack, a stent or bypass surgery. You may also be able to sign up for Advancing Chronic Care with Effective, Scalable Solutions (ACCESS). It started July 5, 2026, for people with Original Medicare. For lower cholesterol, see high cholesterol and Medicare.
If you have heart failure, rehab is covered when your heart's pumping strength (ejection fraction) is 35% or less. You must still have symptoms after at least 6 weeks of treatment. ACCESS adds heart failure on April 1, 2027, Medicare says. Medicare may also pay for monthly care for one serious health problem.
If you have atrial fibrillation (AFib), it isn't on the rehab or ACCESS lists on its own. Tests like a heart monitor are covered at 20%, and blood thinners go through your drug plan.
What will heart medicines cost in 2026 and 2027?
In 2026, the most you pay for covered drugs is $2,100, and in 2027 it rises to $2,400. Since January 1, 2026, Medicare has set lower prices for Eliquis, Xarelto, Entresto and Farxiga, Medicare says. Medicare's price for 30 days of Eliquis is $231, down from a $521 list price in 2023, Medicare says.
On January 1, 2027, Xarelto and Entresto leave the price list because generics are now sold, Medicare says. Check your drug plan's list for the coming year during Open Enrollment, each fall from October 15 to December 7.
If big copays come early in the year, the Medicare Prescription Payment Plan spreads them into monthly bills. It doesn't lower the total. Extra Help does: $5.10 for generics and $12.65 for brand-name drugs in 2026.
What does Medicare pay after a heart hospital stay?
After a heart hospital stay, Medicare pays for rehab, follow-up visits and care at home if you qualify. A nurse may visit if it's hard for you to leave home. See after a hospital stay and home health care.
What to do next
- Ask your doctor for a cardiac rehab referral before you leave the hospital, or at your first follow-up.
- Ask which heart problem you have, since it decides your rehab and ACCESS choices.
- Bring every pill bottle to your first heart doctor visit, so your list matches.
- Compare drug plans during Open Enrollment, especially if you take Xarelto or Entresto. See Medicare Open Enrollment.
- Apply for help with costs, because Original Medicare's 20% has no yearly limit.
If you also have Medicaid
If you're a Qualified Medicare Beneficiary (QMB), no rehab center or doctor may bill you for Medicare's 20%. Medicaid in California and New York may also pay for rides to rehab. See Medicare and Medicaid together and the rules in California and New York.
What a Pair Team advocate does
Heart disease often comes with high blood pressure, diabetes and kidney disease. Each one adds visits and pills to keep straight. This is what we do:
- Book your heart doctor visits and tests, and follow up on results with your care team.
- Ask your doctor for the rehab referral, and set up rides to your sessions.
- Check your blood pressure and weight readings with you between visits.
- Help with Extra Help forms, your fall drug plan check, and food or bill help.
An advocate is covered by Medicare if you qualify. It takes two minutes to find out.
Check if you qualify for a Pair Team advocate
Frequently asked questions
Does Medicare cover heart surgery?
Yes, Medicare covers heart surgery your doctor says you need, like bypass or a valve repair. Part A, your hospital insurance, pays for the stay after the $1,736 deductible. Part B pays 80% of the approved amount for your surgeon, after its deductible.
Does Medicare pay for a second opinion before heart surgery?
Yes, Medicare pays for a second opinion before surgery that isn't an emergency. You pay 20% after the deductible. If the two doctors disagree, Medicare also pays for a third opinion.
Does Medicare pay for heart failure care at home?
Yes, Medicare pays for heart failure care at home if your doctor orders it and it's hard to leave home. You pay nothing for nurse or therapy visits. Equipment like a walker is 20%.
What if my heart failure is serious?
If your heart failure is serious, ask about palliative care, which helps with symptoms at any stage. Medicare may also pay for a navigator if it puts you at high risk of a hospital stay. See palliative care.
Who can I call with heart questions?
You can call the American Heart Association at 1-800-242-8721, weekdays 7 a.m. to 7 p.m. Central time. For Medicare questions, call 1-800-MEDICARE (1-800-633-4227).
Sources
- Cardiac rehabilitation programs, Medicare.gov
- 42 CFR 410.49, Cardiac rehabilitation programs, eCFR
- Diagnostic non-laboratory tests, Medicare.gov
- Principal care management services, Medicare.gov
- Principal illness navigation services, Medicare.gov
- Second surgical opinions, Medicare.gov
- Support for chronic health conditions (ACCESS), Medicare.gov
- ACCESS Model, CMS
- Selected drugs and negotiated prices, CMS
- Negotiated prices for 2026, CMS
- Medicare Prescription Payment Plan, Medicare.gov
- 2026 Medicare Parts A and B Premiums and Deductibles, CMS
- Heart disease facts, CDC
- Cardiac rehabilitation, Million Hearts
- Key Facts About Medicare Drug Price Negotiation, KFF
- Contact us, American Heart Association
About the author
Dr. Nate Favini
Chief Medical Officer
Dr. Nate Favini is Pair Team's Chief Medical Officer. He has led the clinical team since 2023.
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