- Atrial fibrillation (AFib) is a heart condition that affects your heart’s rhythm and output and can cause stroke.
- Medicare covers many treatments for AFib, including medications and medical procedures, such as ablation.
- If you have Medicare Advantage, you may have to choose an in-network provider in order to receive your AFib care.
- Read Part D (prescription drug) formularies carefully to ensure your AFib medications are covered.
Atrial fibrillation (AFib) is a heart condition that affects many adults as they get older. Since it’s becoming a more common condition, it’s good to know that Medicare will cover many medications and treatments for AFib.
However, you’ll still need to pay for any copayments, deductibles, and other costs related to your care.
Keep reading to find out how Medicare covers you when you have AFib and what you should know about managing this condition.
Medicare is divided into several parts. Each part is responsible for covering different aspects of healthcare.
Here’s a basic overview of what each part of Medicare covers:
- Part A. Part A covers hospital and inpatient costs. Some of the services covered under Part A include:
- hospital stays
- medications and procedures provided during your stay
- limited stays at a skilled nursing facility or inpatient rehabilitation facility after you’re discharged from the hospital
- Part B. Part B pays for:
- doctor’s office visits
- outpatient procedures
- diagnostic services
- physical therapy
- durable medical equipment (DME), such as a cane or wheelchair
- Part C. Part C is also known as Medicare Advantage. With this plan, a private insurance company provides your Part A and Part B benefits. These plans typically also offer Part D (prescription drug) benefits. You often need to choose in-network providers and pharmacies to experience the greatest cost savings with a Part C plan.
- Part D. Part D is a prescription drug plan that you purchase through a private insurance company. Each plan has its own unique list of covered medications, called a formulary, that’s based on a tier system. Medications you take at home on a daily basis for AFib would usually be included in a Part D plan.
- Medigap. Medicare supplement insurance, or Medigap, is a policy you can purchase in addition to original Medicare (parts A and B). This policy can help reduce your out-of-pocket costs for coverage.
Managing AFib can require:
- doctor’s office visits
- medications to control your heart rate and prevent stroke
- procedures to manage severe symptoms
Next, we’ll go over the specifics of what Medicare will cover for the diagnosis and treatment of AFib.
Doctor’s office visits and testing
AFib can cause symptoms such as an irregular heart rate and feeling faint. Your doctor will usually detect the condition using a diagnostic test called an electrocardiogram, or EKG.
Medicare covers this test, and what you pay depends on where the test is done.
If you’re at a hospital or hospital-owned clinic, you may pay a copayment to the hospital. If you’re at a doctor’s office, you’ll pay 20 percent of the Medicare-approved amount, provided you’ve met your deductible.
You’ll likely also see a cardiologist (heart specialist) for regular appointments to check the status of your AFib. You’ll be responsible for the Part B or Part C copayment for these doctor’s visits.
Doctors will often prescribe medications to control your heart rate and sometimes anticoagulants (blood thinners) to reduce stroke risk.
Medications your doctor may prescribe to manage your AFib include the following:
- Antiarrhythmics. These medications help your heart beat in a normal rhythm. Examples include sodium channel blockers (flecainide) or potassium channel blockers (amiodarone).
- Antiplatelet medications. Aspirin is the most common example of an antiplatelet medication. They’re used to help keep blood clots from forming.
- Anticoagulants. These medications work differently than antiplatelets but also reduce risks for blood clotting. Examples of anticoagulants include warfarin (Coumadin), dabigitran (Pradaxa), or apixaban (Eliquis).
- Medications to control heart rate. AFib can cause your heart to beat too fast, which affects its ability to pump out enough blood. A doctor may prescribe medications that include beta blockers (atenolol, carvedilol, and metoprolol), calcium channel blockers (diltizem), and digoxin.
Medicare requires Part D plans to cover at least two medications in key categories, such as beta blockers or anticoagulants.
It’s important to carefully read your plan’s formulary to ensure it covers the specific medicines your doctor prescribes.
Doctors may recommend surgical or nonsurgical approaches — or both — to treat AFib. These can include:
- Cardiac ablation. AFib often results from irregular electrical activity in your heart. A cardiac ablation is a minimally invasive procedure that “maps” the heart’s electrical activity. A specialty physician, called an electrophysiologist, uses this map to “burn,” or ablate, areas where the irregular electrical activity is coming from.
- Pacemaker implantation. A pacemaker is a device that helps the heart maintain a steady rhythm. Medicare will cover pacemaker implantation when you have certain symptoms associated with AFib. These include feeling faint, dizziness, confusion, or seizures. However, not all people with AFib need a pacemaker.
- Physical therapy/cardiac rehabilitation. Medicare may approve cardiac rehabilitation under certain circumstances, such as after coronary artery bypass surgery, heart attack, stable chronic heart failure, or placement of a coronary stent. Cardiac rehabilitation typically involves participating in about 36 sessions over a 12-week period.
- DME items. Medicare also covers DME under Part B. While there aren’t specific devices that treat AFib, supportive equipment like a cane or walker can help support you if you have frequent episodes of feeling faint or dizzy.
Often, Medicare will require you to obtain a precertification or approval before you have a procedure.
This process ensures that Medicare will cover your costs for the procedure and provide you with an estimate of how you much you may pay.
You may also have follow-up appointments with your physician after these treatments.
Medicare covers a wide variety of medications and treatments for AFib, but there are always exceptions. This may be true for the following:
- experimental treatments
- medications that aren’t on your plan’s formulary (a list of covered prescription drugs)
- out-of-network providers if you have Medicare Advantage
- treatments or diagnostic tests performed without precertification
Your doctor will have to certify that your treatments for AFib are medically necessary for Medicare to cover them. If Medicare doesn’t have the appropriate paperwork, it may reject your claim.
AFib is a medical condition that causes the upper chambers of the heart to quiver instead of squeeze to send blood to the heart’s lower chambers. This condition can be problematic for several reasons.
First, it keeps blood from pumping effectively from your heart because the chambers aren’t squeezing in rhythm.
Second, the extra time your heart spends quivering can allow clots to form in the heart. When your heart squeezes again, the squeeze can send the clot out and potentially cause a stroke. According to the American Heart Association, you are nearly five times more likely to have a stroke if you have AFib.
An estimated 5 percent of people ages 65 and older (the age when most people qualify for Medicare) have AFib, according to a 2016 research review. This number increases to 10 percent by age 80.
AFib can cause symptoms such as:
- irregular heartbeat
- shortness of breath
- chest pain
Proper management of AFib is important to avoid these symptoms as well as potentially fatal effects.
- Medicare covers many medications and treatments for AFib, but you may have to pay deductibles and copayments.
- If left untreated, AFib increases your risk of stroke.
- Always try to get precertification for AFib procedures, and check prescription drug plan formularies to ensure Medicare covers your medications.