Costs Associated with Heart Attack + Will Health Insurance Cover it All?

Cathy Jakicic
May 6th, 2020 April 14th, 2020 |
Read time: 11 minutes
health care provider and heart

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Heart disease is the leading cause of death in the United States — one in every four deaths is attributed to heart disease each year. That means someone dies of cardiovascular disease every 37 seconds.[1]

About 18.2 million adults over age 19 have coronary artery disease (CAD) — a common form of heart disease. And while most deaths from CAD happen in older people, two in 10 deaths happen in adults under age 65.[2]

What causes a heart attack? A heart attack usually occurs when one or more of your coronary arteries become blocked. A heart attack can also be caused by a spasm of a coronary artery that shuts down blood flow to part of the heart muscle.[3]

There are a number of factors that could put you at a higher risk for a heart attack, in the remainder of this article we’ll talk about:

  • Risk factors for a heart attack
  • Reducing your risk
  • Women and heart disease
  • The potential costs of treating a heart attack
  • Health insurance options that can help with costs

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What Are Risk Factors for a Heart Attack?

The risk factors listed below can mean an increased risk of a heart attack, but they don’t cause heart attacks.

Individual risk factors can include:

  • Age – The risk of heart disease increases for men after age 45 and for women after age 55.[4]
  • Race – According to a report from the 2017 Centers for Disease Control and Prevention (CDC), black males were more likely to die of heart disease. A similar difference was found between black and white females.[5]
  • Sex – The same report found that men, in general, were more likely to die from heart disease than women.[6]
  • Family history – The risk of heart disease increases if your father or a brother was diagnosed with heart disease before 55 years of age, or if your mother or a sister was diagnosed with heart disease before 65 years of age.[7]
  • Preeclampsia – A condition that can develop during pregnancy, preeclampsia is linked to an increased lifetime risk of heart disease.[8]
  • Diabetes – Adults with diabetes are two to four times more likely to die from heart disease.[9]
  • Depression – Adults with symptoms of depression have a 64% greater risk of developing CAD.[10]

Can You Reduce Your Risk of Having a Heart Attack?

You may be able to reduce your risk for experiencing a heart attack by addressing the following risk factors:

Eat a healthy diet. Eat a variety of nutrient-rich, health-promoting foods, like fruits, vegetables, and whole grains.[11]

Eat a diet that supports existing health conditions as indicated by your doctor, such as reduced sodium if you have high blood pressure, avoiding trans and saturated fats if you have high cholesterol or CAD,[12] and eating a diet that helps balance blood sugar if you have diabetes.[13]

Get regular healthcare. Work with your healthcare providers to manage high cholesterol, high blood pressure, diabetes and mental health conditions like depression.[14]

Get physical activity. Especially aerobic exercise like brisk walking, swimming and cycling; resistance training like lifting weights; and stretching, flexibility and balance training. Aim for 30 minutes a day, five days a week for aerobic exercise and stretching.[15]

Manage stress effectively. Chronic stress increases your risk for a number of health problems ranging from depression, digestive problems, and sleep issues to heart disease.Try meditating, getting more sleep and seeking mental healthcare services like counseling if needed.[16]

Drink alcohol in moderation. While some studies have shown an association between moderate alcohol intake and a reduced risk of dying from heart disease, it’s hard to determine cause and effect. In any case, for most people, having an occasional drink doesn’t appear to be harmful; that means one to two drinks per day for men and one drink per day for women.[17]

Quit smoking. Smoking is a major contributor to heart disease, with cigarette smokers two to four times more likely to get heart disease than nonsmokers, and exposure to secondhand smoke posing a health risk to pregnant women, infants, and young children. According to the CDC, 34,000 nonsmokers die from heart disease each year.[18]

Women and Heart Disease

Heart disease is the leading cause of death in the U.S. for men, women, and people of most racial and ethnic groups (2015-2017).[19]

That said, cardiovascular disease remains under-diagnosed and under-treated in women due to the diagnostic challenges it presents, but also due to the long-held attitude that heart disease primarily affects men.[20]

One of the reasons heart disease and heart attack is challenging to diagnose is that women’s symptoms can be very different from those of men, and can actually be mistaken for other health conditions, like the flu or acid reflux.[21]

While women can experience the “classic” symptoms of a heart attack like left-arm pain, chest pain or pressure, they are more likely than men to have symptoms unrelated to chest pain, such as:[22]

  • Shortness of breath
  • Pain or pressure in the upper back
  • Pain in one or both arms
  • Sweating
  • Dizziness, light-headedness, fainting
  • Extreme (unusual) fatigue
  • Indigestion, heartburn, nausea or vomiting
  • Neck or jaw pain

And a woman with heart disease can sometimes be symptom-free until they experience a serious cardiac event, including a heart attack, heart failure or arrhythmia (palpitations).[23]

Some heart disease risk factors that appear to impact women in particular include:[24]

  • Diabetes
  • Mental stress and depression
  • Smoking
  • Being post-menopausal
  • Complications during pregnancy, including high blood pressure or diabetes
  • Family history of early heart disease

If you have any of the symptoms or risk factors for heart disease discussed in this article, it would be a good idea to speak with your doctor about your concerns. And if you’re experiencing symptoms of a heart attack, you should call 911 immediately.

The Potential Costs of Treating a Heart Attack

Heart disease cost the United States about $219 billion each year in 2014 and 2015, according to the most recent CDC data available. This included the cost of healthcare services and medicines, as well as lost productivity.[25]

By 2035, the total cost of cardiovascular disease is expected to reach $1.1 trillion ($749 billion in direct medical costs and $368 billion in lost productivity) when more than 130 million Americans are expected to have some form of cardiovascular disease.[26]

For an individual and their family, the cost of a heart attack can be high.

The cost of treating heart disease varies, but here are some examples of the types of care and costs that often accompany a cardiac event or diagnosis:

  • Hospitalization for heart attack: $5,426 to $16,955 or more[27]
  • Hospitalization for heart failure: $4,819 to $15,058+[28]
  • Cardiac stent: $17,132 to $53,533+[29]
  • Coronary angiogram: $6,318 to $19,741+[30]
  • Left heart catheterization: $5,618 to $17,553+[31]
  • Angioplasty (venous): $2,416 to $7,550+[32]
  • Aortic valve replacement with bypass:$39,604 to $123,758+[33]

For most people, health insurance is a good option for helping with the high costs of care and treatment after a heart attack, from emergency care to hospitalization to surgery.

Health Insurance to Help With Costs After a Heart Attack

There are a few health insurance options that could help with the costs of treating a heart attack.

You will primarily want to consider ACA-qualifying medical insurance and, depending on your situation, may want to add a supplemental medical plan like:

Let’s look at these in more detail.

Qualifying Major Medical Insurance

First and foremost, for someone facing a heart attack, ACA-qualifying health plans cover emergency services, and that includes emergency care that you may receive at an out-of-network facility. In fact, your insurance company cannot charge you more for obtaining ER care at an out-of-network facility or force you to obtain prior approval.[34]

Preventive and wellness services, as well as chronic disease management, are also essential benefits required by the Affordable Care Act.

So screening and treatment for diabetes, high cholesterol and high blood pressure, common contributors to heart disease risk, typically would be fully covered. Remember, the patient is responsible for deductible, copays and coinsurance costs.[35]

The ACA also requires that major medical policies be guaranteed-issue, so you can’t be denied coverage or charged a higher premium if you have a pre-existing condition,[36] however, your premium will likely be higher if you’re older and/or use tobacco.[37] In addition, there are no annual or lifetime benefits limits — also important if you’re dealing with a chronic condition.[38]

For all of these reasons, qualifying health coverage, whether it’s an employer’s group plan, one you purchase individually, or you obtain it another way (like Medicaid), is your most comprehensive coverage option if you experience a heart attack.

All that said, major medical plans with high deductibles or narrow networks can sometimes leave a patient with high costs that their policy will not cover. That’s where supplemental health insurance could be helpful. We’ll talk about that next.

Supplemental Critical Illness Insurance

In addition to the out-of-pocket costs with a major medical policy, you may also have out-of-network costs, non-medical expenses, and of course, your major medical premiums will still need to be paid each month to maintain your policy.

On top of that, if you experience a critical medical condition like a heart attack, you’ll likely need to take time off work to recover and may experience loss of income. All of that can leave you low on cash even if you have a “comprehensive” health plan.

Critical illness insurance could help in this situation. This type of policy generally has a relatively low premium, but only covers a limited number of illnesses, such as a heart attack, stroke or cancer.[39]

A critical illness policy usually pays a lump sum — which typically could be a few thousand dollars up to $100,000 – to help with those costs that may not be fully covered by your major medical insurance. Additionally, the funds can be used for non-medical costs like transportation or housing. Critical illness policies pay out once and then are done.[40]

Your premiums are usually based on a range of factors, including your gender, age, health and family history as well as the benefits level you select. Critical illness insurance is not guaranteed-issue, so you have to be approved by the carrier in order to enroll in a policy.[41]

Learn more about critical illness insurance and whether or not it’s worth it.

Get a quote for a critical illness policy to compare costs and coverage. It just takes a minute.

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Supplemental Gap and Hospital Indemnity Insurance

Other supplemental insurance you may want to consider include gap health insurance and hospital indemnity insurance. Both plans can help cover the high costs of hospitalization that may be associated with recovering from a heart attack or undergoing a procedure like a bypass.

Gap provides supplemental benefits as a lump sum. Get a quote for gap insurance.

Hospital plans provide benefits as a fixed amount on a per event, day, week, month or visit frequency. Get a quote for hospital indemnity coverage.

Summary + Next Steps

Heart attacks are a leading cause of death in the United States.[42]

While some risk factors for a heart attack are beyond your control, such as age or family history, you may be able to reduce your risk with healthy lifestyle choices like eating a diverse, nutrient-rich diet, engaging in regular exercise and effective stress management.

ACA-qualifying major medical insurance is probably your best choice for benefits and coverage to help with the high costs of treating coronary artery disease and heart attack, but supplemental critical illness, medical gap or hospital insurance can provide additional benefits if needed.

If you’re considering supplemental coverage, call 888-855-6837 to speak with an agent to review your options, or obtain quotes for the health plans you’re considering to compare costs and coverage.

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Originally Published On April 14th, 2020
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