For 14 years, Medicare had a rule for people with a badly narrowed heart valve who felt fine: wait. Come back when you can’t climb the stairs, when your chest hurts, when you faint. Then we’ll pay to fix it.
On Sept. 10, Medicare threw that rule out.
If you or someone you love has been told to “watch and wait” on a heart valve, this is the most important Medicare news you’ll read this year. Here’s what changed, who it helps and what to ask your doctor.
The disease you can have without knowing it
The valve in question is the aortic valve, the door between your heart’s main pumping chamber and the rest of your body. With age, it can stiffen and narrow. Doctors call that aortic stenosis.
It’s common. Medicare’s decision memo says more than 12% of beneficiaries 65 and older have it, and more than 3% have the severe form. Harvard Health puts the odds at about 1.3% in your 60s, climbing to about 10% by 80.
Most people find out the same way: A doctor hears a murmur, orders an ultrasound of the heart called an echocardiogram, and there it is. Symptoms, when they come, include shortness of breath, chest tightness, dizziness, fainting and exhaustion, according to Mayo Clinic.
The problem is that “when they come” part. Severe aortic stenosis can sit there, silent, while the heart strains against it. Medicare’s memo cites one large U.S. study that found that roughly 45% of patients with untreated severe disease were dead within four years.
What Medicare changed
The fix these days is often a procedure called TAVR: transcatheter aortic valve replacement. Instead of opening the chest, doctors thread a new valve up through an artery, usually in the leg. Cleveland Clinic says many patients go home the same day or the next.
Medicare first agreed to cover TAVR in 2012, and updated the rules in 2019. Both times, it covered only people who already had symptoms. Everyone else waited.
The Sept. 10 decision does three things, according to the final decision memo:
Coverage for people with no symptoms. For the first time, Medicare will pay for TAVR in patients with severe aortic stenosis who haven’t developed symptoms yet, as long as they’re treated in a study approved by the Centers for Medicare & Medicaid Services. More on that catch below.
Fewer strings for people with symptoms. Since 2012, even symptomatic patients were covered only under something called “coverage with evidence development,” a research requirement. That requirement is gone for them.
Looser rules on who can do it. Hospitals still need a heart team that includes a cardiac surgeon and an interventional cardiologist, but the procedure itself can now be done by a single operator instead of requiring both. Volume requirements for doctors and hospitals were also revised, which should mean more places qualify.
The study that forced Medicare’s hand
Medicare didn’t change its mind on a whim. It changed because of a trial with an unsubtle name: EARLY TAVR.
Researchers took 901 people with severe aortic stenosis and no symptoms, average age 76, and split them in two. Half got the valve right away. Half got the old Medicare approach of careful monitoring, then treatment when symptoms showed up.
Over a median of nearly four years, 26.8% of the early-treatment group died, had a stroke or landed in the hospital for a heart problem. In the wait-and-see group, it was 45.3%.
And the waiting didn’t save many people a procedure. About 87% of the watch-and-wait group ended up getting a new valve anyway, typically within about a year. They just got it after something went wrong.
The results were published in The New England Journal of Medicine in October 2024. The U.S. Food & Drug Administration approved the first valve for symptom-free patients in May 2025. Medicare took another 16 months to follow.
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Who qualifies, and the catch
Let’s be precise, because a headline like this one can send a lot of people to their doctor demanding a surgery they don’t need.
This isn’t for everyone with a murmur. It’s for people whose echocardiogram shows severe aortic stenosis. “Moderate” doesn’t count yet. Your cardiologist will know which category you’re in.
There’s also a real catch for the symptom-free group. Medicare covers them only inside a CMS-approved study that compares early TAVR against surgery or continued monitoring. That means the procedure has to happen at a hospital participating in one of those studies, and you have to enroll.
For years, nearly every hospital doing TAVR reported to a national registry run by the surgeons’ and cardiologists’ professional societies, so the infrastructure is there. But whether a given hospital is part of an approved study for symptom-free patients is a question to ask directly.
What to ask your doctor
If you’ve been told you have aortic stenosis, or anyone’s ever mentioned a murmur, here’s your list for the next appointment.
How severe is it, by the numbers? Ask for the valve area and the blood-flow velocity from your last echocardiogram. Severe has a definition, and you’re entitled to know where you stand.
When was my last echo? Harvard Health says people with severe stenosis should get one every six to 12 months. If it’s been longer, ask why.
Does the new Medicare decision change my plan? Some cardiologists will have read the memo. Some won’t have yet. Bring the date: Sept. 10, 2026.
Is this hospital part of a CMS-approved study for patients without symptoms? If the answer is no, ask which nearby hospital is.
Am I a TAVR candidate or a surgery candidate? The two aren’t interchangeable, and the heart team decides.
What it costs you
TAVR is done in a hospital, so the big pieces fall under Medicare’s usual rules. If you’re admitted, the 2026 Part A deductible is $1,736. Doctor services fall under Part B, with its $283 deductible and 20% coinsurance.
The echocardiogram that gets you diagnosed is a Part B diagnostic test. Medicare.gov says you pay 20% of the approved amount after the deductible when a doctor orders it to find or treat a problem.
A Medigap policy picks up most or all of those out-of-pocket costs. If you’re in a Medicare Advantage plan, it has to cover what Original Medicare covers, but it may require prior authorization and steer you to in-network hospitals. Call before you schedule anything.
For everything Medicare still won’t pay for, see “Retirees, Beware: Medicare Will Not Cover These 11 Medical Costs.”
Bottom line
I’m 71. I’ve watched a lot of government rules outlive the evidence behind them. This one made people with a fixable heart problem wait until it damaged them, and it kept doing so for nearly two years after the trial showed waiting was the worse bet.
That’s over now. If you’ve been waiting, stop. Make the appointment, bring the questions and find out which side of “severe” you’re on.
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