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Learn how Medicare covers open heart surgery and how much you might expect to pay for the procedure.
Original Medicare (Medicare Part A and Part B) and Medicare Advantage (Part C) typically cover open heart surgery when it’s medically necessary. Continue reading to learn more about how Medicare covers open heart surgery, the out-of-pocket costs involved and how a Medicare Supplement (Medigap) plan can help cover the costs.
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The different parts of Medicare insurance can contribute coverage to open heart surgery.
Open heart surgery requires an inpatient hospitalization. Once you are admitted for your surgery, you will begin a benefit period that requires a $1,676 deductible in 2025.
Once you meet your Part A deductible, you will not owe any Part A copayments or coinsurance for the next 60 days of inpatient care received within the same benefit period. This includes stays at a hospital or an inpatient rehab facility.
If you transition to a skilled nursing facility after your open heart surgery, you will not owe any Part A coinsurance for the first 20 days of inpatient care within the same benefit period.
Medicare Part B requires an annual deductible of $257 in 2025. Once that deductible is met, you will typically be responsible for a 20% coinsurance charge applied to covered services and items. Medicare will pay for the remaining 80% of those charges.
After satisfying your Part B deductible, you can generally expect to pay 20% coinsurance charges for:
You will likely be prescribed prescription medications both before and after your surgery, which may be covered by a Medicare Advantage Prescription Drug Plan or a Medicare Part D plan. These plans are sold by private insurers so the amount of coverage provided will vary by plan.
Lastly, a Medigap plan can provide open heart surgery coverage for:
If you are enrolled in a Medicare Advantage plan, your surgery will be covered as long as it would be covered under Original Medicare. Your deductible, copayments and coinsurance may differ from Original Medicare.
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There are around a dozen different types of open heart surgery, so the cost can vary greatly depending on the type of procedure being performed along with other factors such as the facility and doctors involved.
Costhelper.com reports the range of open heart surgery falling anywhere between $30,000 and $200,000 without insurance in 2024.
It’s typical for open heart surgery patients to undergo inpatient rehabilitation. Medicare Part A covers inpatient rehab when certified as medically necessary by a doctor.
Your Part A deductible for inpatient rehab is shared with your hospital deductible, so once you meet the deductible during your hospital stay, you will continue your post-deductible coverage phase during inpatient rehabilitation.
You will have a combined 60 days of inpatient care within the same benefit period between hospital stays and stays at an inpatient rehabilitation facility which are fully covered and do not require any coinsurance.
If those 60 days are exhausted, you will begin to owe copayments of $419 per day for days 61 through 90, and $838 per day for days 91 and beyond in 2025.
After day 90, you use what are called your lifetime reserve days. You only have 60 lifetime reserve days to use for as long as you have Medicare. Once you use your 60 lifetime reserve days, you're responsible for the full cost of inpatient stays that last longer than 90 days. A Medicare Supplement plan can help pay for these costs.
Inpatient rehabilitation coverage includes a semi-private room, nursing services, meals, prescription drugs and the therapy itself. Rehabilitation for open heart surgery can include physical and occupational therapy.
There are a number of ways in which a Medicare Supplement plan can help with open heart surgery coverage.
The Medicare Part A inpatient deductible of $1,676 per benefit period can be fully covered by a Medigap plan in 2025. The Part B deductible of $257 per year can be covered for those who were eligible for Medicare before Jan. 1, 2020, if they have Medigap Plan F or Plan C.
The daily Part A copayments you can incur with stays at a hospital, skilled nursing facility or rehab facility can be fully covered by a Medigap plan, as can the Medicare Part B coinsurance charged for doctor’s appointments and durable medical equipment.
Open heart surgery requires a blood transfusion, and Original Medicare does not cover the first three pints of blood used. But a Medigap plan can provide full coverage of those first three pints that Original Medicare will not cover.
Medicare Part B allows certain health care providers to charge up to 15% more than the Medicare-approved amount. These are called “excess charges,” and a Medigap plan can cover them in full.
Original Medicare has no annual out-of-pocket limit, and an open heart surgery can cost tens or even hundreds of thousands of dollars. Even after Medicare pays its share, you can still be responsible for many thousands of dollars in the form of deductibles and copayments.
Two Medigap plans provide an annual out-of-pocket limit that can protect you from the exorbitant costs associated with open heart surgery. Plan K has an out-of-pocket limit of $7,220 in 2025, while Plan L has an out-of-pocket limit of $3,610.
Heart bypass surgery, or coronary bypass surgery, is a type of open heart surgery that creates a new path for blood to flow around a blocked or partially blocked artery in the heart. This is the most common type of open heart surgery and is covered by Medicare in the same fashion as outlined above.
Medicare generally covers surgeries that are considered by a doctor to be medically necessary and are FDA approved. If you are unsure about whether or not a surgery will be covered by Medicare, you may call 1-800-MEDICARE (1-800-633-4227) for help.
If you are enrolled in a Medicare Advantage plan, call the phone number on your Plan ID card to speak with a representative from your plan about surgery coverage. It’s important to remember that Medicare Advantage plans are required by law to cover everything included in Part A and Part B.
Learn more about how a Medicare Supplement plan can help cover the potentially high out-of-pocket Medicare costs you might face when having open heart surgery. Call to speak with a licensed insurance agent today to compare plan costs, or request a free online plan comparison.
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Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareSupplement.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
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