Medicare and heart disease in Oregon

Heart disease is a leading health concern for people with Medicare, and cardiac care can be costly even with good coverage. For Oregonians managing coronary artery disease, heart failure, atrial fibrillation or recovery after a heart event, here's what Medicare covers and where the costs fall.

Screening and prevention

• Cardiovascular disease screening: blood tests for cholesterol, lipids and triglycerides once every 5 years. You pay nothing if your provider accepts assignment.
• Cardiovascular behavioral therapy: one visit a year with your primary care provider to help lower your risk, including blood pressure checks and diet advice. You pay nothing if your provider accepts assignment.
• Abdominal aortic aneurysm screening: a one-time ultrasound, with a referral, for people at risk, such as men 65 to 75 who have smoked at least 100 cigarettes or anyone with a family history. You pay nothing if your provider accepts assignment.

Diagnostic tests, such as EKGs, echocardiograms, stress tests, cardiac CT and catheterization, are covered when medically necessary. Outpatient, you pay 20% of the Medicare-approved amount after the Part B deductible ($283 in 2026; CMS announces 2027 amounts in the fall).

Treatment

Hospital care

Inpatient stays for a heart attack, heart failure or heart surgery are covered under Part A. You pay the Part A deductible for each benefit period ($1,736 in 2026) and nothing more for days 1 to 60.

Procedures

• Stents (angioplasty), pacemakers, implantable defibrillators and catheter ablation for atrial fibrillation: Part A if you're admitted as an inpatient, Part B if done as an outpatient.
• Bypass surgery and most valve replacements, including TAVR, are usually inpatient (Part A).
• Whether you're an inpatient or an outpatient under observation affects what you pay and whether a later skilled nursing stay is covered; ask the hospital.

Cardiac rehabilitation

Part B covers regular and intensive cardiac rehabilitation programs, including exercise, education and counseling, if you've had at least one of these: a heart attack in the last 12 months, coronary bypass surgery, stable angina, a heart valve repair or replacement, coronary angioplasty or stenting, a heart or heart-lung transplant, or stable chronic heart failure. You pay 20% of the Medicare-approved amount after the deductible, plus a copayment for each session in a hospital outpatient program. Many Oregon hospitals run cardiac rehab programs; ask your cardiologist for a referral, including to a program near home.

Heart medicines

Most heart drugs are covered by Part D plans according to each plan's formulary:

• statins, beta blockers, ACE inhibitors and ARBs, many of them generic;
• blood thinners such as Eliquis and Xarelto;
• heart-failure drugs such as Entresto, and SGLT2 inhibitors such as Jardiance and Farxiga; and
• cholesterol drugs such as Repatha for higher-risk patients.

Eliquis, Entresto, Xarelto, Jardiance and Farxiga had Medicare-negotiated prices starting January 1, 2026. CMS lists Entresto and Xarelto as removed from the negotiated list effective January 1, 2027. Covered Part D drug costs are capped at $2,400 in 2027 ($2,100 in 2026). Drug guides: Eliquis, Xarelto, Jardiance, Farxiga and Repatha.

Heart failure care

Heart failure care means frequent visits, weight checks and medication changes. Medicare covers office and telehealth visits with your cardiologist under Part B; telehealth from home is covered through December 31, 2027. Home health is covered if you're homebound and need skilled nursing, and hospice is covered when a doctor certifies a life expectancy of six months or less.

Choosing coverage with heart disease

• Original Medicare lets you see any cardiologist or hospital that accepts Medicare, including heart centers in Portland, Seattle or Boise. A Medigap policy can pay the 20% coinsurance on tests, procedures and rehab.
• Medicare Advantage plans use networks and may require prior authorization for procedures and imaging; check that your cardiologist and hospital are covered. Each plan has a yearly in-network out-of-pocket limit (no more than $9,850 in 2027). Medicare Advantage plans may offer extra benefits such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.
• Compare drug lists. If you take a brand-name blood thinner or heart-failure drug, check how each plan covers it. You can check plans for your drugs or request a call from a licensed insurance agent.

Related guides

Sources

• Medicare.gov — Cardiovascular disease screenings
• Medicare.gov — Cardiovascular behavioral therapy
• Medicare.gov — Abdominal aortic aneurysm screening
• Medicare.gov — Cardiac rehabilitation
• Medicare.gov — Inpatient hospital care
• Medicare.gov — Telehealth
• CMS — Selected drugs and negotiated prices

Frequently asked questions

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