Heart disease is the leading cause of death among Medicare beneficiaries. Medicare spends more on cardiovascular care than any other condition category. This guide summarizes what Medicare covers for cardiovascular health in 2026, and links to our detailed coverage guides for each area: disease screenings, medications, and treatment through ACCESS.

The three pillars of Medicare cardiovascular coverage

1. Cardiovascular disease screenings

Medicare covers basic lipid panels (free every 5 years), diagnostic cardiac imaging (stress tests, echocardiograms, cardiac CT), and diagnostic EKGs. All diagnostic tests are subject to the Part B deductible ($283 in 2026) and 20% coinsurance.

In general, Medicare doesn’t cover advanced lipid biomarkers like Lp(a) and ApoB.

2. Cardiovascular medications

Medicare Part D covers all the major cardiovascular drug classes, but access and cost vary dramatically:

Drug class	Monthly cost	Access barriers
Generic statins	$0-$10	None
Ezetimibe	$0-$15	Minimal
PCSK9 inhibitors	Capped at $2,100/year total	Extensive prior auth + step therapy
GLP-1s (for diabetes)	Plan-dependent	Prior auth
GLP-1s (for CV risk)	Plan-dependent	Prior auth; must have established CVD
GLP-1s (for weight loss)	Not covered	Statutory exclusion

The Inflation Reduction Act transformed cardiovascular medication costs. Medicare now has a $2,100 annual out-of-pocket cap, elimination of the coverage gap, and negotiated prices for Eliquis, Entresto, Xarelto, Jardiance, and Farxiga (effective 2026) and Ozempic, Rybelsus, and Wegovy (effective 2027). The Bridge program launches July 2026 to offer GLP-1s for $50/month GLP-1s for eligible beneficiaries.

Read the full guide to Medicare cardiovascular medication coverage —>

3. Medicare’s new ACCESS program

Medicare is launching ACCESS in July 2026 with two cardiovascular tracks: Early Cardio-Kidney-Metabolic (eCKM), which covers hypertension, dyslipidemia, obesity, and prediabetes, and Cardio-Kidney-Metabolic (CKM), which covers diabetes, chronic kidney disease, and atherosclerotic cardiovascular disease.

ACCESS pays for remote monitoring, virtual consultations, digital coaching, and medication management. Some ACCESS providers, like Empirical Health, offer $0 patient copays.

If you’re a referring physician, read our guide to the ACCESS model and referrals here.

What’s changing about Medicare cardiovascular coverage in 2026-2027

Development	Timing	Impact
ACCESS model launch	July 2026	Outcome-based payment for cardiovascular chronic conditions, $0 copays
BALANCE GLP-1 bridge	July 2026	$50/month GLP-1s for eligible Medicare beneficiaries
Negotiated drug prices (round 1)	January 2026	Lower prices for Eliquis, Entresto, Xarelto, Jardiance, Farxiga
Negotiated drug prices (round 2)	January 2027	Lower prices for Ozempic, Rybelsus, Wegovy
BALANCE full Part D integration	January 2027	GLP-1 coverage within Part D benefit structure
Part D OOP cap	$2,100 (2026)	Hard annual cap on prescription drug out-of-pocket costs

The combination of the ACCESS model, BALANCE program, drug price negotiation, and Part D redesign represents the most significant expansion of Medicare cardiovascular coverage since the ACA. The shift from paying for activities to paying for outcomes (ACCESS) and from list prices to negotiated prices (IRA) are structural changes that will shape cardiovascular care for years to come.