OBJECTIVES: Financial equity is one of the most challenging issues in health policy. Cardiovascular disease (CVD) is one of the leading causes of death worldwide and cardiovascular patients contribute significantly to guide and allocate financial resources equitably and efficiently. The aim of this study is to evaluate the horizontal and vertical financial equity in hospitalized cardiovascular patients (CVPs) in Isfahan, Iran. METHODS: This is a cross-sectional study. The population includes all hospitalized CVPs with and without insurance in both public and private hospitals in Isfahan. Sampling was conducted using the stratified random sampling method. To collect data, a self-administered questionnaire and hospital bills were used. The socioeconomic status of the patients determined from the data collected by the questionnaire. Vertical and horizontal financial equity were analyzed using Kolmogorov-Smirnov and Kruskal-Wallis statistical tests. These financial equity were reported based on the types of cardiovascular disease and patients’ insurance coverage. RESULTS: Our findings indicated that public hospitals had the most proportion (78.9%) of hospitals in Isfahan. Blood pressure with 53.9% had the highest frequency and congenital heart with 2.8% had the lowest rate of cardiovascular types. In terms of socioeconomic classification, poor class with 69.4% had the highest frequency. The distribution of out-of-pocket payments for patients in different insurances policies showed that there is serious sign of horizontal financial inequity between various health insurance policies. Likewise the distribution of out-of-pocket payments was almost the same within different socioeconomic classes; which could be consider as sign of vertical financial inequity. CONCLUSIONS: There are strong signs of horizontal and vertical financial inequity amongst hospitalized CVPs. Health insurance coverage has not had positive impact for improving financial equity for CVPs. Iranian health system needs serious reform for improving financial equity for CVPs.