How Health Care Reform Affects Your Heart Care

Medically Reviewed by Sarah Goodell on June 16, 2020

You will find it easier to manage heart problems with the Affordable Care Act. Helping you manage chronic diseases is an important part of health care reform. This includes helping you lower your risk for heart attack or stroke.

Managing Heart Disease

If you buy health insurance through your state's Marketplace, on the individual market, or through an employer with 50 or fewer employees, your plan must cover certain Essential Health Benefits. You may need some of these services as a heart patient, such as:

Be aware that each state determines the details of exactly what must be covered under these categories. Individual health plans may add to those minimum requirements. So before you enroll, read the plan's summary of benefits to see what specific services you’ll have access to and what your costs will be.

Medicare includes the essential health benefits. So does Medicaid in some states. Medicare and Medicaid also offer special programs for home monitoring of blood pressure and other heart risks.

If you get insurance through your job, check your health plan to confirm the details of your coverage. Large employers are not required to offer the essential health benefits, but nearly all do.


Reduced Costs to Treat Heart Disease

The Affordable Care Act has rules about the most you have to pay out-of-pocket for your medical care.

  • Health plans cannot impose annual or lifetime dollar limits on your benefits.
  • Your out-of-pocket costs will be limited. Health plans will have what is called an out-of-pocket maximum. Once you reach that amount through your deductibles and other cost-sharing, your insurance company covers the rest of your costs. That includes what you would spend on copays and deductibles for medical services and prescriptions. The out-of-pocket maximum does not include your monthly premiums.
  • You might be able to get financial help to pay for some costs if you're buying insurance through your state's Marketplace. You may be able to get a tax credit to lower your insurance premiums. You can find your state’s Marketplace by going to
  • You might qualify for Medicaid coverage, even if you haven't in the past. This will depend on how much you earn and the state you live in. See Medicaid Expansion: At-a-Glance to learn more. You can find out whether you qualify for Medicaid by going to your state’s Marketplace.


Savings on Drug Costs for Seniors

If you're on Medicare and take medicine for a heart condition, you may be pleased to know the doughnut hole -- the gap in Medicare coverage for prescription drugs -- is slowly going away. It will be gone by 2020, leaving you to pay just 25% of the cost of your brand-name and generic medications. See What Medicare Costs, Part D to get the details, including what discounts are available until the doughnut hole closes.

Buying and Keeping Insurance Will Be Easier

With a chronic heart problem, you will have many protections under the Affordable Care Act:

  • You cannot be dropped by your health plan because you have a heart problem or a condition that can lead to heart disease, such as high blood pressure or high cholesterol.
  • You cannot be turned down for health insurance coverage because of a heart problem.
  • You cannot be charged more for health insurance because you have a heart condition.

* Short-termhealth plans, thosethat offer coverage for less than 12 months, do not have to offer the essential health benefits and can still deny coverage for pre-existing conditions.

Show Sources


American Heart Association: "Health Care Reform and You."

CDC: "Control of Hypertension Among Adults - National Health and Nutrition Examination Survey, United States, 2005-2008." "Closing the Coverage Gap - Medicare Prescription Drugs Are Becoming More Affordable."

U.S. Preventive Services Task Force: "USPSTF A and B Recommendations."

White House: "Historic Consumer Protections Take Effect, On Time."

Community Catalyst & Georgetown University Health Policy Institute: "Federal Subsidies: Helping People Afford Health Care."

U.S. Department of Health & Human Services: "2013 Poverty Guidelines."

Kaiser Family Foundation: "Visualizing Health Policy: Medicaid Expansion Under the Affordable Care Act."

Robert Wood Johnson Foundation: "Chronic Disease Management."

Centers for Medicare and Medicaid Services: "Readmissions Reduction Program."

American Telemedicine Association: "Telemedicine in the Patient Protection and Affordable Care Act."

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