Medicare and Open-Heart Surgery: Is there Coverage?
Open-heart surgery is a general term that refers to any surgery where a surgeon accesses the heart by opening the chest. They'll make an incision in your chest and then cut through the breastbone and spread your ribs.
Open-heart surgery treats a range of heart conditions, such as:
heart failure
heart valve disease
arrhythmias
aneurysms
coronary artery disease
Medicare Part A coverage
Medicare Part A covers inpatient hospital care. This means it will cover the open-heart surgery itself.
Part A will also cover your inpatient pre- and post-op care, including:
semiprivate room
meals
general nursing
medications you receive while in the hospital
any other hospital services or supplies as part of your inpatient stay
»Learn more: Medicare Part A
Medicare Part B coverage
After open-heart surgery, you may require cardiac rehabilitation. If this is the case, then Medicare Part B will typically cover these programs.
You may require cardiac rehabilitation after surgeries like coronary artery bypass and a heart valve repair or replacement.
Cardiac rehabilitation services typically include:
exercise
a program to reduce cardiac risk factors, such as nutrition counseling
psychosocial assessment of mental health and emotional needs
individualized treatment plan
outcome assessment
»Learn more: Medicare Part B
Medicare Advantage coverage
Medicare Advantage (Part C) is an alternative to Original Medicare (parts A and B) that's provided by Medicare-approved private insurance companies.
Medicare Advantage plans must provide the same coverage as Original Medicare. This means Medicare Advantage will also cover open-heart surgery.
Cost of open-heart surgery with Medicare
The cost of the surgery with Medicare Part A comes with out-of-pocket expenses. The Part A deductible is $1,676.
After the deductible is met, you're responsible for paying the following copayments based on how long you're in the hospital:
Days 1 to 60: $0 after deductible is met
Days 61 to 90: $419 per day
Days 91 to 150: $838 while using lifetime reserve days
After day 150: total cost
Part B coverage also has a deductible of $257 in 2025. After this amount is met, you're responsible for 20% of the Medicare-approved costs for cardiac rehabilitation if you receive it in a doctor's office. If you receive cardiac rehabilitation in an outpatient hospital setting, you'll also be responsible for paying the hospital copayment.
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