What is the Financial Impact of a Heart Attack?

Heart disease is the leading cause of death in the United States, which can lead to heart attacks.¹ Heart attacks are major medical events that can take a serious toll on your body, but also on your finances. Although health insurance typically covers many costs associated with heart attacks, there may be gaps or coverage limits that force you to pay out of pocket for specialized care or increases in living expenses. With a critical illness insurance policy, you can get extra financial support to help pay for what health insurance doesn’t. Here, we explore the financial impact of a heart attack and how critical illness insurance can help.

How much does a heart attack cost?

Heart attacks vary based on several factors, but the American Heart Association has found that the mean cost of an acute myocardial infarction (AMI) is $18,300 per hospitalization.² Typically, your primary health insurance plan will cover much of these costs. However, heart attacks could reveal other conditions that may require lifelong monitoring and specialized treatment. This can increase the cost of a heart attack, and your health insurance might not cover it all. Some limitations of health insurance may include:³

• No coverage for pre-existing conditions that may have caused an initial cardiac event
• Limited cardiologist choice based on a provider network
• Complications in switching coverage or policies if you change jobs
• Waiting periods for specialized care

These potential limitations and the added cost of heart attacks may make critical illness insurance worth it for you.

What is critical illness insurance?

A critical illness insurance policy typically pays cash benefits when you experience a qualifying major medical event, like a heart attack or stroke. Each plan functions differently but are usually structured to provide added financial support to help cover things that aren’t covered by health insurance. You can use the cash benefits of a critical illness policy to pay for whatever you need most, including:

• Medical expenses
• Everyday living expenses, like groceries and rent
• Other important out-of-pocket expenditures

Because benefits are paid in cash, direct to the policyholder, unless assigned otherwise, it’s up to you how to use them. With benefits from critical illness insurance, you can opt for specific treatments that aren’t covered by your health plan or use the benefit for what is important to you.

What does critical illness insurance help cover?

Here’s what you need to know if you’re wondering, “what does critical illness insurance cover?” Each critical illness insurance plan has different benefits and conditions. Usually, they provide coverage for specified conditions so, but it’s important to review the policy to understand what is explicitly covered and not covered.

It’s just as important to know what critical illness insurance doesn’t cover. In some cases, you may want to consider alternative or additional supplemental plans. For instance, hospital indemnity insurance may provide benefits for the hospital care that is related to your condition.

How does critical illness insurance work?

Critical illness insurance is similar to health insurance in that you pay a monthly premium to keep your policy active in exchange for coverage. However, it’s not a replacement for health insurance and functions differently. Whereas medical providers typically bill your health insurer for treatments and services, with a critical illness insurance policy, you must submit a claim yourself. For instance, if you have active coverage at the time of your qualifying diagnosis, the claims process may look like this:

1. You contact your insurer for the correct way to file a claim.
2. You submit your claim with medical documentation of your diagnosis.
3. Your insurer reviews the claim and pays eligible cash benefits direct to the policyholder, unless assigned otherwise, which can help you with medical bills, or living expenses.

The bottom line

A heart attack can have significant financial consequences. Although health insurance may provide benefits for some treatment, heart attacks can have long-term and unpredictable care needs. A critical illness insurance policy can pay cash benefits directly to the policyholder, unless assigned otherwise, to help you and give you additional peace of mind while you recover.

Sources:

¹ CDC – Heart Disease Facts. Updated October 24, 2024. https://www.cdc.gov/heart-disease/data-research/facts-stats/index.html. Accessed May 13, 2025.

² AHA|ASA Journals – Cost of Cardiovascular Disease Event and Cardiovascular Disease Treatment–Related Complication Hospitalizations in the United States. Published February 8, 2024. https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.123.009999. Accessed May 13, 2025.

³ American Heart Association – Insurance Coverage and Heart Defects. Updated September 18, 2023 https://www.heart.org/en/health-topics/congenital-heart-defects/the-impact-of-congenital-heart-defects/insurance-coverage-and-heart-defects. Accessed May 13, 2025.

Content within this article is provided for general informational purposes and is not provided as tax, legal, health, or financial advice for any person or for any specific situation. Employers, employees, and other individuals should contact their own advisers about their situations. For complete details, including availability and costs of Aflac insurance, please contact your local Aflac agent.

Aflac coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, Aflac coverage is underwritten by American Family Life Assurance Company of New York.

Critical Illness/Specified Health Event, A74000 series: In Delaware, Policies A74100DE, A74200DE, A74300DE. In Idaho, Policies A74100ID, A74200ID, A74300ID. In Oklahoma, Policies A74100OK, A74200OK, A74300OK. In Virginia, Policies A74100VA, A74200VA, A74300VA. A73000 series: In Delaware, Policies A73100DE & A7310HDE. In Idaho, Policies A73100ID & A7310HID. In Oklahoma, Policies A73100OK & A7310HOK. In Virginia, Policy A73100VA & A7310HVA. B71000 series: In Delaware, Policies B71100, B71200, B7130H & B7140H. In Oklahoma, Policies B71100OK & B7110HOK.

Hospital, B40000 series: In Delaware, Policies B40100DE & B4010HDE. In Idaho, Policies B40100ID & B4010HID. In Oklahoma, Policies B40100OK & B4010HOK. In Pennsylvania, Policies B40100PA & B4010HPA. In Virginia, Policies B40100VA & B4010HVA.

Coverage underwritten by Tier One Insurance Company:

Critical Illness: In Delaware, Policy T71000. In Oklahoma, Policy T71000OK.  In Virginia, Policy T71100VA

Coverage may not be available in all states, including but not limited to DE, ID, NJ, NM, NY, VA or VT. Benefits/premium rates may vary based on state and plan levels. Optional riders may be available at an additional cost. Policies and riders may also contain a waiting period. Refer to the exact policy and rider forms for benefit details, definitions, limitations, and exclusions.

Aflac WWHQ | Tier One | 1932 Wynnton Road | Columbus, GA 31999