Medicare Pays $50,000 for a Heart Attack but Won't Spend $100 to Prevent One
Medicare Will Pay $50k for Your Heart Attack. It Should Pay $100 to Prevent It
Cardiologists Arthur Agatston and Oren Mechanic argue that coronary artery calcium scans, a 10-minute test costing about $100, can spot dangerous plaque years before a heart attack. After three decades of evidence, the ACC and AHA finally gave CAC a central role in their March 2026 prevention guidelines. Yet insurers still won't cover it, so doctors reserve the scan for patients who can pay cash. AI reading calcification on existing chest CTs could change that.
What we have lacked is a payment system that spends $100 to avoid a $50,000 emergency.
- getpost
Scripps cardiologist Eric Topol (not commenting on this article): "That's wrong. The CAC is anything but definitive. Many patients are told they have significant coronary artery disease by calcium score and it turns out, by CT angiography or cardiac catheterization, they have normal arteries.
No less anxiety (often chronic and severe) and unnecessary procedures that are induced by false positive CACs." https://x.com/EricTopol/status/2092682606815117763
Coronary calcium scans quantify calcified atherosclerotic plaque but cannot reliably distinguish stable plaques from rupture-prone plaques or detect noncalcified plaques, some of which may be particularly vulnerable.
https://www.ahajournals.org/doi/pdf/10.1161/JAHA.118.008564
https://www.jacc.org/doi/10.1016/j.jcmg.2017.03.005
https://www.atherosclerosis-journal.com/article/S0021-9150(1...
- jimmydddd
I'm too young for medicare, but when I asked my dr. to prescribe the heart scan, he kept stalling. When I followed up, he said my insurance wouldn't pay for it. Then I checked into pricing and it was $130 lol. If I have a family history, why would he assume I didn't want to pay the $130? I later found out that the his medical practice gets penalized by the insurance company for recommending "too many tests." So that plays into it.
- goodmythical
What I've never understood is the weird dichotomy of preventive and reactive governance in the minds of US citizens.
We're willing to spend god knows what shooting rounds that cost entire mortgages to save miltary lives and project a presence of power to deter acts of terror/war, but then are also totally fine having people way as much as 4 or 5 people, eating several days worth of sugar for breakfast, smoking tobacco, putting 3 cups of coffee in a can we drink 4 or five of in a day, do next to nothing to adress recidivism of all classes of criminal, drag our feet kicking and screaming in to a semblance of modernity in worker protections...
- brandonb
Coronary CT calcium scans are getting more popular. But before getting one, I'd do these simpler tests first:
- ApoB - about 20% of people with normal cholesterol results will have abnormal ApoB, and be at risk of heart disease.
- Lp(a) - the strongest hereditary risk factor for heart disease.
- hs-CRP - inflammation roughly doubles your risk of heart disease
- HbA1c - insulin resistance is a risk factor for just about everything.
- eGFR - estimates the volume of liquid your kidneys can filter, and is an input to the latest heart disease risk models (PREVENT).
These are simple blood tests. You can get them for <$200 through my company or others:
https://empirical.health/product/comprehensive-health-panel
Imaging is great for detecting calcified plaque in your coronary arteries. But before you have calcified plaque, the above risk factors tell you about the buildup of soft plaque. And 4 out of 5 of them are modifiable through lifestyle, exercise, and medication.
- hungryhobbit
Its the fundamental problem of our age: everyone is building pieces of a system, and almost no one is actually looking at how those pieces fit together into a system.
This is not about (just) the healthcare system ... it's the core problem with:
- our legal system (millions of laws and rulings and zero effort spent reconciling them into a good system that treats everyone equally)
- our economic system (we reward people who create true wealth in many different ways ... but those rewards are wildly disproportionate to how much true wealth they add)
- our tax system (again, millions of laws, and yet the people who should be paying the most pay the least because of how they fit together)
- our electrical system (although, due to its centralization, this one is actually catching up much faster than the rest)
- insert any other system here
- dubeye
This is a little bit misleading.
'Preventing a heart attack' means taking life long medication to reduce the absolute risk of heart attack by about 1%, which is worth doing, but complicates the maths a little bit. The scan doesn't magically eliminate heart attack risk
- flerchin
The argument made in the article seems inarguable, but I don't see how a coronary artery calcium score is going to prevent a heart attack. You gotta do statins, exercise, and eat right basically no matter what. FWIW I had a coronary artery calcium score ordered by my doctor at my last checkup. It was $120.
- tkdb
Insurance was invented to pay for emergencies. Your home insurance doesn't pay to perform routine maintenance on your roof, but neither will it pay to repair "normal" wear and tear. Your home insurance pays when a tree falls on your roof.
Our healthcare system has co-evolved with insurance in a sort of partial free-market, partial heavily regulated environment. Arguably we get the worse parts of both: Kafka-esque beaurocratic mazes and shareholder value optimization for private firms.
There's a paradigm shift needed in how health insurance works: optimize for total cost of care.
Can the invisible hand do this when providers are offering mainly treatments with token preventative care visits thrown in?