Does Medicare Cover Atrial Fibrillation (AFib)


Atrial fibrillation, also known as AFib, is a serious heart condition that affects an estimated 2.7 million U.S. adults. It causes an irregular heart rhythm and can lead to a stroke or blood clots in the heart.

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Medication and treatment can be expensive, but fortunately, Medicare covers both. In this article, you’ll learn about treatment options, costs, coverage, and more.

Does Medicare Cover Atrial Fibrillation Treatments?

Original Medicare covers different treatments for atrial fibrillation, as long as they’re medically necessary.

If a beneficiary needs to stay as an inpatient at a hospital because of AFib, Part A may cover their stay. Doctor visits, diagnostic exams, and screenings fall under; Part B. Treatment for AFib varies and includes different procedures, surgical or nonsurgical.

Treatment options for AFib include:

  • Atrial fibrillation ablation surgery
  • Prescriptions that help regulate heart rate and rhythm
  • Lifestyle changes to help promote heart health
  • Blood-thinning medications that can reduce the chances of strokes

Your doctor may request an electrocardiogram (EKG) to evaluate your heart health and check for different conditions. Medicare covers this diagnostic testing, but your out-of-pocket costs depend on where you get the test. You’re responsible for paying coinsurance for Part B, or copayments on a Medicare Advantage plan when you have an appointment with a cardiologist.

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Does Medicare Cover Cardioversion?

Medicare Part A covers cardioversion. Cardioversion is a medical procedure that helps repair an abnormal heartbeat.

There are different types of cardioversion:

  • Electrical cardioversion – This is a low voltage shock that helps to regulate your heartbeat.
  • Chemical cardioversion – Chemical cardioversion is a procedure that uses medications via IV in a hospital to restore the heartbeat.
  • Catheter ablation: A doctor uses a flexible thin tube (catheter) through the heart during this procedure. The catheter uses high energy to create small scars, eliminating cardiac tissue that causes the abnormal rhythm.
  • Surgical ablation: Surgical ablation, also known as a maze procedure, is performed during open-heart surgery. It involves the removal of tissue that triggers an irregular rhythm.

Does Medicare Advantage Cover Atrial Fibrillation?

Medicare Advantage (Part C) is essentially a bundled plan. It provides benefits for both Part A and Part B.

These plans generally include prescription drug benefits.

With Medicare Advantage, you may have to choose health care providers within your network to get the most coverage from your plan. If you choose to receive care from out-of-network providers, you may have to pay out-of-pocket.

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Do Medicare Supplement Plans Cover Atrial Fibrillation?

Medicare Supplement, or Medigap, plans can be a lifesaver for those who have high costs. But, if you have AFib, it’s especially important to know the times when you can get the plan of your choice.

If you were diagnosed with AFib, you can still join a Medigap plan. Yet, you’re only guaranteed enrollment in the plan during your Medicare Supplement Open Enrollment Period or when you have a guaranteed issue right. You may apply outside of these circumstances, but you could face denial due to your pre-existing condition.

Does Medicare Part D Cover Atrial Fibrillation Medications?

As you’ve read above, some AFib treatments come in the form of prescription drugs. An oral drug called Eliquis is a common form of treatment for AFib.

It helps prevent clots in the lungs or in the veins. Without insurance, one month’s supply of Eliquis can cost $499. Fortunately, Medicare Advantage and Part D prescription drug plans include most drugs that treat atrial fibrillation.

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FAQs

Does Medicare cover cardiac ablation?
Yes. Ablation has coverage under Part A. This procedure is minimally invasive. It will block the electrical signals that can cause irregular heart rhythms.
Does Medicare cover Cox-Maze and Mini-Maze surgeries, and hybrid surgery ablation?
Inpatient services have coverage under Part A. Cox-Maze is an open-heart surgery that is usually performed along with other heart disease treatments. But, the Mini-Maze is not open-heart surgery. Small incisions are made in the patient’s chest or diaphragm. Hybrid Surgery is where a cardiac electrophysiologist performs a surgical procedure inside the heart, while the surgeon works outside.
Will Medicare cover heart monitors?
Part B benefits will cover heart monitoring. Also, Part B includes cardiac screenings receive coverage as part of your health visits. But you’ll still pay applicable deductibles and copays. To qualify for a heart monitor, your doctor will need to prove that you’re high-risk.
Will Medicare cover AFib catheter ablation?
Catheter ablation is a popular form of treatment among AFib patients. Medicare will cover a catheter ablation under your Part A benefits. Catheter ablation can be incredibly expensive, it can cost you anywhere from $16,000 – $22,000 for the procedure. Plus, you’ll have annual upkeep charges that can cost a couple of thousand dollars per year.

How to Get Help with Medicare Coverage for Atrial Fibrillation

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Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

6 thoughts on “Does Medicare Cover Atrial Fibrillation (AFib)

  1. My Cardiologist recommends (insists) that I get cardiac catheter ablation for the electrical circuitry in my upper heart chambers. I understand the procedure. It would take place as an outpatient procedure at North Shore Hospital In Long Island NY.

    I have limited savings and I need to understand what the actual cost would be for me to have the procedure. I’m 68 and I have Medicare A & B only.

    Can you help me get a handle on what would be My out-of-pocket costs? I see the surgeon on the 29th and he’ll want to get started right away.

    Thanks for your consideration.

    Respectfully,

    Robert Riscica

    1. Hi Robert! Since each doctor and hospital is different, you would need to discuss your out of pocket costs with your doctor. In general, you would be responsible for 20% of the costs since Part B only covers 80%. You would also be responsible for the Part B deductible.

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