How Much Will You Pay for Open-Heart Surgery If You Have Medicare?

Heart disease is the leading cause of death in the U.S. In fact, heart disease is responsible for about 1 in 5 deaths. The most common type of heart disease is coronary artery disease, which can result in conditions such as heart attack and heart failure. 

Many people with heart disease can extend their lives with open-heart surgery — a broad category that includes several types of procedures. Coronary artery bypass graft, known as CABG, is the most common type of heart surgery.

Medicare covers open-heart surgery. What you’ll pay depends on your Medicare plan and your procedure.

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How much does open-heart surgery cost without insurance?

Heart disease is among the most expensive health conditions in the U.S. You will likely face high costs whether you have surgery or receive medication treatment. Without insurance, open-heart surgery costs might range from less than $30,000 to $200,000 or more depending on the procedure.

A 2024 study of more than 500 U.S. hospitals found that CABG prices ranged from $57,240 to $75,047.

Types of open-heart surgery

There are several types of open-heart surgeries. Some of the most frequently performed include:

• CABG: This is the most common cardiovascular surgery in the U.S. and treats coronary artery disease.

• Heart valve repair or replacement: These procedures treat heart valve conditions, such as aortic valve stenosis.

• Maze procedure: This surgical intervention treats atrial fibrillation.

• Artificial heart or ventricular assist device placement: These procedures treat heart failure.

• Heart transplant: This organ replacement treats heart failure.

• Surgical myectomy: This open-heart surgical procedure is used to treat the genetic condition hypertrophic cardiomyopathy.

How does Medicare cover open-heart surgery?

Original Medicare (Part A and/or Part B) will cover open-heart surgery if it is medically necessary. But most people have some out-of-pocket costs. Here is an explanation of how each part of Medicare covers open-heart surgery.

Part A

CABG typically takes place in hospitals, where you’ll remain for several days during your recovery. Medicare Part A covers inpatient hospital stays, though you will be responsible for your deductible, which is $1,632 per benefit period in 2024.

Part B

Medicare Part B will cover outpatient procedures or certain physician services you receive while you're in the hospital. After you meet your annual deductible, which is $240 in 2024, Part B covers 80% of Medicare-approved costs. You will be responsible for the other 20%.

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Medicare Advantage (Part C)

Medicare Advantage, a private alternative to original Medicare also known as Part C, will meet or exceed what original Medicare covers. If you have a Medicare Special Needs Plan, a distinct type of Medicare Advantage plan, you could pay very little out of pocket.

Part D

We will discuss what Part D prescription plans cover in a later section.

Medigap

Medigap is an insurance supplement that helps with out-of-pocket costs for original Medicare enrollees. People enrolled in Medicare Advantage plans aren’t eligible for Medigap.

How much does open-heart surgery cost if you have Medicare?

Your out-of-pocket costs for open-heart surgery with original Medicare will depend on:

• The specifics of your procedure

• Where you have your services, because that determines whether Part A and/or Part B provides coverage

• If you have Medigap supplement insurance and how much the plan covers

Your costs will vary if you have a Medicare Advantage plan. And if you have Medicare Advantage, you won’t be able to use a Medigap plan because they can only be used with original Medicare.

While Medicare will pick up many of the costs associated with open-heart surgery, most people with original Medicare are responsible for their Part A and Part B deductibles as well as 20% of the approved Part B costs. 

Original Medicare and Medicare Advantage plans cover hospital services (inpatient and outpatient), doctor’s office care, and some medications for enrollees who have open-heart surgery.

Will Medicare Part D cover your medications after the surgery?

As you recover, you will likely need prescription medications at home. A Medicare Part D prescription plan that’s a standalone policy or included in your Medicare Advantage plan can help you cover some of the costs.

What you’re charged for your medication depends on whether your prescription is on your plan’s formulary and tiers. You may be responsible for out-of-pocket costs associated with your Part D plan, such as a deductible, copayments, and coinsurance.

Will Medicare cover devices like a stent, pacemaker, or defibrillator?

Medicare will cover devices that are deemed medically necessary for your cardiovascular health. After open-heart surgery, that may include the following.

Implantable automatic defibrillator

These devices are surgically implanted to prevent sudden death for people with high risk of life-threatening irregular heartbeat. Some defibrillators also have a pacemaker function that stimulates the heart if the rhythm is too slow. 

Original Medicare may cover this device if you have been diagnosed with heart failure. Medicare Part A pays if the surgery happens in an inpatient hospital setting. Medicare Part B picks up the tab for a defibrillator implant in an outpatient hospital setting. You will pay the Part B deductible and 20% of the Medicare-approved amount for your doctor’s services. You also will pay a hospital copayment that won’t be more than the Part A deductible.

Ventricular assist devices 

VADs include the left ventricular assist device (LVAD), which is a mechanical pump for patients with end-stage left-sided heart failure. The LVAD is either a short-term bridge to a heart transplant or serves as long-term circulatory support for advanced heart failure. LVAD implantation qualifies as an inpatient hospital service under Part A and as a prosthetic under Part B.

Will Medicare cover cardiac rehab?

Medicare will likely pay for medical services you need as you recover from open-heart surgery. Cardiac rehabilitation is a medically supervised, comprehensive, and personalized intervention combining exercise, education, and counseling for people recuperating from a wide range of cardiac conditions. 

A cardiac rehab program typically includes 36 sessions after discharge. You’ll complete the program in a hospital, rehabilitation facility, or at home. 

Medicare and Medicare Advantage plans will cover cardiac rehab as long as you meet your health plan’s medical criteria and have a healthcare professional’s referral. Original Medicare covers most of the cost for enrollees who have had a heart attack in the past 12 months as well as those who have had procedures including:

• Bypass surgery

• Heart transplant

• Valve repair or replacement

Enrollees pay 20% of the Medicare-approved amount for cardiac rehab provided in a doctor’s office. For services in a hospital setting, you also are responsible for a copayment. In both instances, the Part B deductible applies. Medicare usually covers up to 36 sessions. If medically necessary, patients can be covered for 72 sessions, which is called intensive cardiac rehabilitation or ICR.

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Written by:

Tamara E. Holmes

Tamara E. Holmes is a Washington, DC-based freelance journalist and content strategist who has been writing about personal finance, health, and health insurance for more than a decade. Her work has appeared in various print and online publications, such as USA Today, AARP, Working Mother, and Diversity Woman.

Edited by:

Cindy George, MPH

Cindy George is the senior personal finance editor at GoodRx. She is an endlessly curious health journalist and digital storyteller.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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