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Does Medicare Cover Aneurysm Scans and Treatment?

Aneurysms have a terrifying reputation, and for good reason. They can be debilitating or deadly when they strike, and they can strike without warning or symptom. Keep in mind, there are different types of aneurysms, too, each defined by where they occur in the body. For all these reasons, there are several ways that we watch for aneurysms, especially in people with a family history of them. Since age can be a major risk factor in developing an aneurysm, it would make sense that Medicare helped cover the screening and treatment costs, right? Well, there’s only one specific instance of aneurysm coverage for Medicare, but that doesn’t mean you’re left high and dry.

What Are Aneurysms?

To quickly define aneurysms so that we have a base level of understanding, they’re a weakening or bulging of a blood vessel. This weakness can eventually lead to a rupture, which puts you at risk of coma, stroke, or death. The severity of the rupture can vary based on where the aneurysm is, but all can be dangerous. Aneurysms can also commonly appear without symptom, meaning you may not know you have one unless it’s caught by your doctor or a rupture occurs.

Abdominal Aortic Aneurysm Scan Coverage

Abdominal aortic aneurysms occur in the lower part of your midsection (below your chest) in the aorta, roughly around the stomach. They’re the more common of the two types of aortic aneurysms, the other being thoracic (above the chest). The most common risk factors of abdominal aortic aneurysms are gender, age and whether one smokes or not. So, the people most at risk for developing this type of aneurysm are males, 65 or older who smoke.

This puts the Medicare population squarely at risk. To help watch for this dangerous condition, Medicare Part B does fully cover a special abdominal aortic aneurysm ultrasound screening. This ultrasound is only covered once in your lifetime and only if you’re considered high risk. To be high risk, you must fulfill one of two conditions:

  • Have a family history of abdominal aortic aneurysms
  • Are a male who is 65 or older and has smoked at least 100 cigarettes in his life

In order to receive coverage for the ultrasound, you must also have received a referral from your doctor or a qualified health care professional and the service provider must accept Medicare assignment. If you fit all these criteria, you should pay nothing for the scan.

Brain Aneurysm Scan Coverage

Brain aneurysms (or cerebral aneurysms) are shockingly common — it’s estimated that one in 50 Americans have an unruptured brain aneurysm. While this number is alarming, 50 to 80 percent of all aneurysms do not rupture and there are ways to lessen the chances of that happening. Catching an aneurysm can push you to make healthier life choices to lower the risks of a rupture, for example. There isn’t one specific scan, like the abdominal aortic aneurysm ultrasound, that is used to identify and diagnose a brain aneurysm. Instead, there are several.

Luckily, all these scans should be covered by Medicare as diagnostic tests.

Specifically, computed tomography (CT) scans and magnetic resonance imaging (MRI) are commonly used to find cerebral aneurysms, along with cerebrospinal fluid (CSF) analysis and cerebral angiography. Luckily, all should be covered by Medicare as diagnostic tests. This will often be covered under Part B, so you’ll owe 20 percent of the Medicare approved amount once you’ve reached your deductible. Keep in mind, the diagnostic tests must be considered either preventive or medically necessary to receive coverage. This type of coverage and diagnostic testing will likely be true for most types of aneurysms since they’re all effective ways to locate and diagnose one. The reason abdominal aortic aneurysms are specifically noted is because Medicare makes a special, noteworthy exception in its coverage for the ultrasound.

Coverage of Aneurysm Treatment

Your treatment options, should you have an aneurysm, may depend on what type of aneurysm it is, but generally, treatment can be broken into two categories — prescription drugs and surgery.

A common solution is to prescribe blood pressure medication to lower your risks of a rupture. Other medications may also be prescribed to manage risks that can follow an aneurysm rupturing. As with many prescription drugs, you should be able to have them covered by a Part D drug plan or a Medicare Advantage plan with prescription drug coverage.

Most of these treatments will be given at an inpatient setting, like a hospital, meaning they’ll be covered under Medicare Part A.

On the surgical side, your doctor may order a procedure that repairs or replaces the damaged or weakened area of the vessel. For aortic aneurysms, this could be open chest repair or endovascular coiling, which protects the vessel from rupturing. A cerebral aneurysm may also be treated with endovascular coiling, there’s also surgical clipping that can be done. This method entails the vessel being clipped to stop blood flow to it and prevent a rupture. Most of these treatments will be given at an inpatient setting, like a hospital, meaning they’ll be covered under Medicare Part A. That said, it’s always wise to ask questions and learn as much as you can about your surgery and coverage before you have the procedure, especially verifying whether you’ll be inpatient or outpatient.

Since smoking is such a major risk factor for aneurysms, it likely will help to quit. Luckily, Medicare can help with that, too! Should the worst happen and a rupture occurs, Medicare can even offer some coverage of emergency services so that you’re getting the potentially life-saving help you need.

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Aneurysms can be scary, but, even though they’re quite common, they aren’t always deadly. In fact, by making smart health choices like lowering your blood pressure or quitting smoking, you can decrease your risk of a dangerous rupture. Finally, if you are ever concerned or show symptoms of an aneurysm, Medicare can help to either assuage your fears or get you answers so you can begin treating the problem.