Medicare covers many medications and medical procedures for atrial fibrillation (AFib), such as cardiac ablation. Part D prescription drug plans may cover different medications.

AFib is a heart condition that affects your heart’s rhythm and output and can cause stroke.

Medicare covers many medications and treatments for AFib but does not cover experimental treatments. 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 care and treatment for AFib.

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Managing AFib can require:

  • doctors’ office visits
  • medications to control your heart rate and prevent stroke
  • procedures to manage severe symptoms

Next, we discuss the specifics of Medicare coverage for diagnosing and treating AFib.

Doctors’ 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 (EKG).

Medicare covers this test, and what you pay depends on where the test takes place.

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% 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 doctors’ visits.

Medications

To manage AFib, doctors often prescribe medications to control your heart rate and sometimes anticoagulants (blood thinners) to reduce stroke risk.

Medications a doctor may prescribe to manage AFib include:

  • Antiarrhythmics: These medications help your heart beat in a normal rhythm. Examples include:
  • Antiplatelet medications: Aspirin is the most common example of an antiplatelet medication. Antiplatelet medications are used to help keep blood clots from forming.
  • Anticoagulants: These medications work differently than antiplatelets but also reduce blood clotting risks. Examples of anticoagulants include:
  • 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:

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 medications your doctor prescribes.

Services and therapies

Doctors may recommend surgical, 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 covers pacemaker implantation when you have specific symptoms associated with AFib, such as confusion, feeling faint or dizzy, 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 12 weeks.
  • Durable medical equipment (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.

Medicare often requires you to obtain a pre-certification 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 much you may pay.

You may also have follow-up appointments with your doctor after these treatments.

Medicare covers various medications and treatments for AFib, but there are always exceptions. Medicare may not cover:

  • experimental treatments
  • medications that aren’t on your plan’s formulary (list of covered prescription drugs)
  • out-of-network providers if you have Medicare Advantage
  • treatments or diagnostic tests performed without pre-certification

Your doctor must 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.

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 pre-certification for AFib procedures and check prescription drug plan formularies to ensure Medicare covers your medications.