The heart is one of the most important organs in the body. Your heart keeps the entire operation running, and when it experiences problems, it can wreak havoc on virtually every other organ and system. While medical technology has come a long way in providing cardiac care through medications and patient education on lifestyle choices, open heart surgery remains a vital option for those who require complex solutions to heart problems.

Open heart surgery was first successfully performed in 1893, and since then, the techniques and tools used to perform this sometimes life-saving procedure have improved tremendously. Survival rates are higher than ever before, and many people who would have died due to cardiac emergencies in the past are now able to enjoy a new lease on life thanks to innovations in open heart surgery.

How is Open Heart Surgery Performed?

An open surgery is one in which a large incision is made so that medical professionals can operate on an internal part of the body. This is different from laparoscopic surgery in which a small incision is made and the operation takes place internally using thin tubes and tools. So, open heart surgery is any type of heart surgery in which the heart is exposed and operated on. This type of surgery carries the greatest number of risks, even with all of the advances made in medical technology, but when required, it can save lives.

In most cases, open heart surgery is performed in the event of an emergency when medical professionals either do not have the tools available for less-invasive measures or when time constraints require immediate and drastic action. A common reason for needing open heart surgery is when blocked arteries need to be bypassed in order to allow for normal blood flow. Even though open heart surgery is usually performed during emergencies, these types of surgeries can be planned if other methods of surgery will incur more risks than benefits.

Does Medicare Cover Open Heart Surgery?

Medicare benefits generally provide coverage for medical treatment that is considered necessary to protect health and wellness. As a result, even if a plan does not specifically address open heart surgery as a covered benefit, the surgery itself will likely qualify for coverage as long as it is deemed medically necessary by a physician or medical specialist. This is the case for emergency heart surgery as well as surgery that is planned.

When an open heart surgery is performed as a planned procedure, coverage can be provided in a few different ways. First, Medicare Part B (Medical Insurance) may offer coverage for the pre-operative care and follow-up appointments. Part A (Hospital Insurance) may be billed for some services if you are formally admitted into a hospital. The patient will likely need to be admitted to a hospital for monitoring prior to surgery. Open heart surgery that is performed during a cardiac emergency in a hospital will also fall under Part A as long as you have been formally admitted.

If the patient requires rehabilitation and treatment in a skilled nursing facility following surgery, this will also likely be covered under Medicare Part A until the patient is released to return home. Finally, prescription medications that are ordered after a successful surgery will usually fall under Medicare Part D coverage as long as the prescribed medications are available for purchase at a retail pharmacy. If you’re questioning whether a specific medication is covered under Part D of your Medicare benefits, you should consult with your plan manager and review your plan’s formulary.

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