Does Medicare Cover Open Heart Surgery?

Written by:

Kayla Missman

Reviewed by:

Jason Kolkey

5 min read

Key Takeaways

Medicare covers medically necessary surgical procedures like open heart surgery.
If you’re on Original Medicare, Part A covers inpatient treatment and a hospital stay following surgery.
Medicare Part B covers outpatient care, doctor’s visits, medical equipment, and cardiac rehabilitation programs. You need a Medicare Part D plan for prescription drug coverage outside of a medical setting.
Medicare Advantage plans must provide at least the same coverage as Original Medicare for open heart surgery. Plans may also provide Part D prescription drug coverage and additional benefits.

Medicare covers medically necessary surgeries, including open heart surgery, when ordered by a doctor. This article explains the costs and coverage requirements for this life-saving procedure, whether you’re insured through the federally administered Original Medicare program or a Medicare Advantage plan from a private carrier.

What is Open Heart Surgery?

Heart disease is a leading cause of death in the United States, accounting for an estimated one in five deaths in 2022, according to the Centers for Disease Control and Prevention (CDC). While heart disease can often be addressed through lifestyle changes and medication, more severe cases may require surgery.

Open heart surgery—cutting open the chest to access the heart—can extend lives. There are many different heart surgeries, but the most common type is a coronary artery bypass. This procedure involves grafting a healthy vein near a clogged artery to allow blood and oxygen to flow into the heart.

Data from the Centers for Medicare and Medicaid Services (CMS), the federal agency that administers Medicare, show that 21% of beneficiaries live with heart disease. If you rely on either Original Medicare or a Medicare Advantage plan for health insurance, you should know how treatments for your heart, including surgery, are covered.

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How Medicare Covers Open Heart Surgery

Original Medicare, which comprises Part A and Part B, helps with the costs of medically necessary procedures to diagnose or treat a health condition. Since open heart surgery is a life-saving measure to treat heart disease, Medicare covers services from participating doctors, hospitals, and specialists.

Part A: Hospital Coverage

Medicare Part A covers inpatient services, such as care in a hospital, skilled nursing facility, or hospice setting. For example, if you experienced a heart attack, were admitted to the hospital, and underwent surgery, that care falls under Part A.

Part A covers all surgery expenses, including anesthesia. It also covers a post-operation hospital stay. Heart surgery commonly requires up to a week of recovery in the hospital. During this period, Medicare covers your room, meals, exams, and medicine.

Part B: Medical Coverage

Part B covers preventative care and outpatient services like your appointments leading up to surgery and any follow-up visits, as well as medical equipment and assistive devices that your doctor considers medically necessary.

Part B also covers cardiac rehabilitation programs, which involve education, counseling, and exercise in either a doctor’s office or hospital outpatient setting.

Medicare Part D

Original Medicare covers medications that you receive during your surgery or hospital stay. However, you’ll need to enroll in a Medicare Part D prescription drug plan from a private insurance carrier to get coverage for medications after you’re released. Otherwise, you’ll pay out of pocket.

How Medicare Advantage Covers Open Heart Surgery

Medicare Advantage plans, sold by private insurance carriers, must cover, at minimum, the same services as Original Medicare. In addition, the plans usually feature Part D coverage and other expanded benefits. Depending on the specifics of your plan, you may have coverage for more comprehensive recovery services and post-op prescription drugs.

Medicare Advantage plans have provider networks to coordinate care and control costs. To get the most out of your coverage, you will need to visit in-network physicians, hospitals, pharmacies, and rehabilitation clinics.

If you’re living with heart disease, you could be eligible for a chronic condition special needs plan (C-SNP). This type of Medicare Advantage plan may feature a provider network, prescription coverage, and a variety of additional benefits that are all geared specifically to the needs of people with a certain condition.

Keep in mind that Medicare Advantage benefits vary by plan, carrier, and region. When in doubt, contact your plan directly to clarify eligibility requirements and coverage terms.

How Much Does Open Heart Surgery Cost With Medicare?

Without insurance, coronary artery bypass surgery could cost up to $84,000 in certain U.S. regions. That doesn’t include exams, rehabilitation, or a hospital stay (which averages $3,025 per day). Insurance companies and Medicare negotiate lower rates with hospitals and healthcare providers.

Your total out-of-pocket expenses will vary based on your insurance plan, the complexity of your surgery, and pre- and post-operation care. Here’s how your costs could break down with Original Medicare:

Part A deductible: A deductible is the amount you pay before insurance kicks in. As of 2025, the Part A deductible is $1,676 per benefit period, much lower than the $21,000 average for a one-week stay.
Inpatient stay: Medicare fully covers your first 60 days in the hospital after you meet your deductible.
Part B premium: The monthly Part B premium costs $185 in 2025.
Part B deductible: You must meet your Part B deductible, $257 in 2025, before Medicare pays for medical services such as outpatient care.
Coinsurance: With Part B, you’ll typically pay 20% of the cost for covered services.

Medicare Advantage uses a different cost structure. Some plans charge a monthly premium in addition to your Part B premium. However, you’ll only have to meet one deductible for in-network care. Unlike Original Medicare, Medicare Advantage plans set an out-of-pocket maximum to limit how much you’ll spend on covered services each year.

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Other Benefits to Consider

Skilled nursing facilities: If you need to recover in a skilled nursing facility, Medicare fully covers your first 20 days after meeting your deductible.
Home health care: Some patients need extra support recovering from surgery. You won’t pay anything for covered home healthcare services with Part A.
Durable medical equipment: Medicare covers 80% of the cost for medically necessary wheelchairs, walkers, and other assistive devices.
Cardiac rehabilitation programs: Medicare covers these programs for individuals who have had a heart attack, heart surgery, or transplant. You’ll pay 20% of the Medicare-approved cost in coinsurance.

Putting It All Together

Medicare covers open heart surgery as a life-saving treatment for heart disease. Having insurance can save you tens of thousands of dollars in medical fees, but your total out-of-pocket costs depend on your situation and insurance plan. If you anticipate needing treatment for a heart condition, consider working with a licensed insurance agent or broker to find the right insurance plan.