Medicare coverage for Atrial Fibrillation (AFIB) is necessary for over two million people. AFib occurs when the two upper heart chambers beat fast and irregularly. The improper functioning of the upper chamber negatively impacts the lower chamber. Treatments for this health condition can be costly; thankfully, Medicare can help.
Supplemental Medicare plans can also help lower your out-of-pocket costs for AFib treatments. Further, prescription drug plans can help make medication more affordable. Although, you may still be responsible for coinsurances, deductibles, or copayments. Keep reading the content below to learn more about AFib treatment and coverage.
Table of contents
- Can I get Medicare health insurance with afib?
- Will Medicare cover doctor visits for afib testing and screenings?
- Will Medicare Cover Pacemaker implantation?
- What AFib treatments aren’t covered by Medicare?
- Will Medicare Advantage plans cover atrial fibrillation?
- How can Medigap help Medicare beneficiaries with afib
Can I get Medicare health insurance with afib?
The federal government health program, Medicare, is provided to anyone at least 65 or those with eligible disabilities. Pre-existing conditions like atrial fibrillation don’t impact your ability to qualify for Original Medicare.
Medicare beneficiaries with AFib should consider signing up for a Medigap policy when first eligible. There is no underwriting during the Medigap Open Enrollment Period, and the private insurance company can’t deny your application for coverage.
Medicare will likely cover services, procedures, and equipment deemed medically necessary by your healthcare provider. If you have additional insurance alongside Medicare, you may have fewer costs.
Is atrial fibrillation considered a chronic condition?
Atrial fibrillation is a heart rhythm condition that can lead to more severe issues such as heart failure or stroke. There are different types of Afib.
Paroxysmal Afib lasts less than a week and is intermittent. Persistent AFib is continuous and lasts less than 12 months but more than a week. Permanent Atrial Fibrillation is continuous and won’t respond to treatment.
Persistent and Permanent AFib both involve continuous heart palpitations, pounding chest, and irregular heart rhythms. An irregular or rapid arrhythmia occurs more often than a normal heartbeat.
Is atrial fibrillation considered a pre-existing condition?
AFib can be a pre-existing medical condition, especially since it can result in other serious medical issues and potentially need continuous maintenance. Also, AFib increases your risk of stroke, which can impact how a company views your health.
A pre-existing health condition is a health issue a person has before enrolling in a health plan. Pre-existing conditions are usually long-standing issues that require a diagnosis and treatment.
With Original Medicare, a pre-existing condition isn’t an issue. But, with Medigap, it could mean paying a higher monthly premium or denying coverage altogether.
You may experience a pre-existing condition waiting period if your coverage is approved. The waiting period is generally a 6-month period where the new insurance doesn’t cover any medical bills associated with Atrial Fibrillation.
However, in most cases, if you have any form of insurance before applying for the Medigap policy, pre-existing limitations won’t apply to you. Medicare beneficiaries concerned about a pre-existing condition should contact us. Our agents can help you find an insurance carrier that covers pre-existing conditions.
Will Medicare cover doctor visits for afib testing and screenings?
Preventive screening services and diagnostic tests in an outpatient facility will have coverage through Part B. One diagnostic test your doctor may run will be an electrocardiogram or EKG to determine if you have Atrial Fibrillation.
A cardiologist is a heart specialist who will check your AFib status. You can expect Medicare to cover medically necessary treatments for your AFib. Although, experimental treatments aren’t likely to have coverage since Medicare only covers treatments approved by the FDA.
Does Medicare cover the treatment of atrial fibrillation?
Once you have an Atrial Fibrillation diagnosis, you start to wonder which treatment procedures Medicare will cover. AFib is expensive to manage because ongoing treatment and surgery may sometimes be required.
Part A covers inpatient services such as hospital stays, procedures, and inpatient rehabilitation when you have a qualifying hospital discharge.
Part B covers outpatient services such as doctor visits, diagnostic services, Durable Medical Equipment (DME), screenings, and physical therapy.
Medicare covers 80% of the cost after you meet applicable deductibles. But, 20% of over $40,000 is a lot of money annually. So, while Medicare does provide you with some insurance, having an additional policy such as Part C or Medigap can save you money.
If the treatment your doctor orders is in the form of a medication you take at home, Medicare won’t cover that. Instead, you’ll need prescription drug coverage to help with the cost of AFib drugs.
Does Medicare cover cardiac rehabilitation?
Medicare will approve cardiac rehabilitation when special circumstances occur, such as after a heart attack, coronary artery bypass, placement of a coronary stent, or stable chronic heart failure. You can expect cardiac rehabilitation to be about 36 sessions in 12 weeks.
Does Medicare insurance cover cardioversion?
Part A covers cardioversion, a medical procedure to repair abnormal heartbeats. There are two main types of cardioversion: chemical cardioversion and electrical cardioversion.
Chemical Cardioversion is when an intravenous medicine is given to get the heart back to a normal rhythm. The treatment takes about five minutes, but with setup and sedation, you can expect the total time to be about 45 minutes.
Electrical cardioversion is when a machine delivers a low-voltage energy shock to get the heart to beat normally. A particular group of cells will send an electrical signal to start your heartbeat.
It’s important to note that electrical cardioversion isn’t the same as defibrillation. Defibrillation uses a more intense shock to the heart for emergency heart rhythm correction.
Does Medicare cover AFib medication?
Medicare doesn’t cover prescriptions you take at home, but Part D prescription drug plans cover medications your doctor prescribes. Part D plans must cover at least two medicines in key categories.
Healthcare providers often write prescriptions for those with AFib to control heart rate or reduce stroke.
Your doctor might prescribe you anticoagulants, antiarrhythmics, antiplatelet medications, or medications to control your heart rate. Anticoagulants reduce your risk of blood clots, also called blood thinners. For example, warfarin is a blood thinner.
Antiarrhythmics help your heart beat normally. Antiplatelet medications keep blood clots from forming, while beta-blockers may be prescribed to control your heart rate.
Be sure to read the plan’s formulary to thoroughly understand the medications your plan covers and how each drug has coverage. Some medicines may require prior authorization, predetermination, or step therapy.
People with a low income might qualify for Extra Help paying for prescriptions.
Will Medicare Cover Pacemaker implantation?
Medicare covers medically necessary pacemakers, so coverage is available if your doctor says you need one. If you have Atrial Fibrillation and your heart beats too slow, your doctor will likely suggest you have a pacemaker.
Other reasons you might need a pacemaker include Tachy-Brady syndrome, where your heart beats fast during AFib and slowly when you’re not. Also, if you take AFib medication that slows your heart rate, you might need a pacemaker.
The pacemaker will aid in the treatment of heart arrhythmia. Medicare will cover both the actual pacemaker device as well as the surgery.
Surgery to implant a pacemaker is costly, but having additional insurance can help lower your costs. If any complications arise during surgery, your costs can increase substantially.
Medicare will cover battery replacements for pacemakers.
What AFib treatments aren’t covered by Medicare?
While Medicare covers an array of treatments and services, there are claims they don’t approve. Medicare may not cover things like experimental treatments the FDA hasn’t approved.
Your doctor must verify that your AFib treatments are medically necessary for Medicare coverage. The claim may face rejection if Medicare doesn’t receive the required paperwork. But you can always appeal a rejected claim.
Diagnostic tests and treatments that don’t have precertification may not have coverage. You’re responsible for the entire cost if your visit doesn’t have coverage.
Part D won’t cover medications that aren’t on the plan formulary. You’ll pay for these prescriptions out of your pocket with no reduction in cost.
Will Medicare Advantage plans cover atrial fibrillation?
Part C Medicare Advantage plans must cover at least as good as Original Medicare, so yes, they will cover Atrial Fibrillation.
The Part C plans that include prescription drug coverage will also help cover the cost of your AFib medications.
The downsides to Medicare Advantage plans for those with serious health issues such as AFib include:
- High out-of-pocket costs
- Having to stay in a specific doctor network
The Part C plan determines the claims that get paid instead of Medicare handling the claim.
However, it’s understandable that Part C would be appealing since the plans are a bundle of benefits. Some programs include a gym membership, over-the-counter benefits, and dental.
Also, some Special Needs Plans could benefit those with cardiovascular disease or a heart condition.
FAQs
Does Medicare cover ablation surgery?
Medicare Part A covers ablation surgery. Surgical ablation is a maze procedure that occurs during open-heart surgery and removes tissues that trigger an irregular heartbeat.
Is a cardiac ablation covered by Medicare insurance?
Part A covers Cardiac Ablation, which is a minimally invasive procedure. The purpose of this procedure is to block electrical signals causing an irregular heartbeat.
Does Medicare cover AFib catheter ablation?
Medicare Part A will cover catheter ablation. The procedure is quite costly, and you can expect to pay upwards of $15,000, not including the annual upkeep charges.
How much does cardiac ablation cost on Medicare?
Medicare Part A covers medically necessary inpatient treatments like cardiac ablation, provided they meet Medicare’s coverage criteria. If your healthcare provider recommends cardiac ablation, Medicare Part A will assist in covering the treatment expenses after you’ve paid the Part A deductible.
What are the Medicare guidelines for radiofrequency ablation?
Medicare will cover the procedure as long as radiofrequency ablation is medically necessary. Radiofrequency ablation uses heat to destroy the tissue that triggers an irregular heartbeat or AFib. Generally, doctors will recommend this therapy when medicine doesn’t help control your rapid heartbeat.
Will Medicare cover Cox-Maze, Mini-Maze surgeries, or hybrid surgery ablation?
Part A covers Inpatient surgeries, and Part B covers outpatient surgeries. The Cox-Maze surgery is open-heart surgery involving cracking the chest open. Usually, this surgery is done alongside other heart treatments.
The Mini-Maze isn’t an open-heart procedure. Instead, the doctor will make a small incision on the diaphragm or chest. A hybrid surgery requires a surgeon to work on the outside of the heart while a cardiac electrophysiologist does surgery on the inside of the heart.
Does Medicare cover Amiodarone?
Yes, Medicare Part D will cover Amiodarone. You’ll be happy to learn that every Part D plan covers this medication. Of course, you should always double-check the plan formulary annually to be sure you’re covered since things change. Amiodarone can be used intravenously or orally for chemical cardioversion.
Does Medicare cover Coolief?
Some private insurance companies that offer prescription drug plans may cover Coolief. Your doctor can confirm with your health insurance provider if you have coverage. Private health plans may require prior authorization or predetermination for you to be eligible.
Will Medicare Part D cover Eliquis?
Prescription drug plans can cover Eliquis. It’s essential to verify with your plan that your medications have coverage. Eliquis is a brand-name drug, and there are currently no generic alternatives. While coverage is available, costs may still be high.
Does Medicare cover heart monitors?
Heart Monitors will have coverage under Medicare Part B. Your doctor will need to prove that it’s medically necessary for you to have a heart monitor. There may be applicable copayments and deductibles.
How can Medigap help Medicare beneficiaries with afib
Medigap insurance benefits those with severe health conditions that would be costly with only Original Medicare. However, if you missed your Medigap Open Enrollment Period, you could be denied coverage due to your pre-existing health condition.
However, our licensed insurance agents are experts, able to identify Special Enrollment Period giving your Guaranteed Issue rights. Or, an agent can help you find a company most likely to approve your application.
Call us at the number above to get started with an expert agent, and we can take the guesswork out of your insurance. If you can’t call now, fill out an online rate form to compare rates in your area.
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