Does Medicare Cover Atrial Fibrillation?
Atrial fibrillation, or AFib, is a serious medical condition in which the beating in the upper chambers of the heart is irregular. Medicare provides coverage for common AFib procedures, including ablations, cardioversions and pacemakers. AFib medications are covered by most drug plans.
What is Atrial Fibrillation?
Atrial fibrillation — also known as AFib — is an irregular and often rapid heart rate that can lead to severe complications and death.
More than 454,000 people are hospitalized with AFib each year in the United States, and the condition contributes to about 158,000 deaths each year, according to the U.S. Centers for Disease Control and Prevention.
During atrial fibrillation, the two upper chambers of the heart beat irregularly and out of sync with the two lower chambers of the heart.
- Heart palpitations
- Shortness of breath
- Weakness and fatigue
- Chest pain
AFib can be a dangerous and deadly condition. Patients with the disease are twice as likely as patients without AFib to die.
A major concern of people with atrial fibrillation is the potential to develop blood clots within the upper chambers of the heart. This leads to an increased risk of stroke.
According to the U.S. Centers for Medicare & Medicaid Services, or CMS, 5 percent of AFib patients suffer a stroke each year.
Strokes are even more common among patients with both AFib and heart failure — and these strokes tend to be either fatal or of moderate to high severity in most patients.
Certain factors can increase your risk of developing AFib, including conditions such as obesity, heart disease, sleep apnea, diabetes and high blood pressure.
AFib may be brief, with symptoms that come and go. Or the condition may be persistent and require ongoing treatment.
Medicare Coverage and Costs of Atrial Fibrillation
Atrial fibrillation can be a costly condition to manage because it often requires ongoing treatment, medications, doctor visits and surgery.
According to CMS, the management of AFib and its complications costs the U.S. health care system roughly $26 billion each year.
If you’re a Medicare beneficiary with AFib, your out-of-pocket costs depend on the services you receive, where you receive them and if you have any supplemental insurance, such as Medicaid or a Medigap policy.
If you’re in Original Medicare (Part A and Part B), you can expect a 20 percent copayment for outpatient services and doctor visits. The $233 Part B deductible applies.
If you are admitted to the hospital as an inpatient, you are covered under Medicare Part A, and the $1,556 deductible applies.
Copayments and coinsurance may differ for beneficiaries enrolled in a Medicare Advantage plan. In most cases, the Part A and Part B deductibles still apply.
Keep in mind that Medicare Advantage plans often restrict you to doctors and providers within the plan’s network. Seeking care outside your network will likely cost more.
AFib Procedures: Cardioversions, Ablations and Pacemakers
If you have AFib, your doctor or health care team will focus on helping you regain a normal heart rhythm, controlling your heart rate and preventing blood clots.
Many options are available to treat AFib, including catheter-based procedures and surgery.
- Electrical Cardioversion
- An electrical cardioversion is a procedure in which a doctor administers an electrical shock on the outside of your chest using paddles or patches. The patient is under mild anesthesia during the procedure. The shock is intended to reset the heart to a normal rhythm.
- Radiofrequency Ablation or Catheter Ablation
- An ablation is used when medications or electrical cardioversions are not effective. During an ablation, small burns or freezes are created to cause some scarring on the inside of the heart and disrupt the electrical signals that cause irregular heartbeats. This can help the heart maintain a more normal rhythm.
- Some people with AFib need a pacemaker, which is a small battery-powered device that sends weak electrical impulses to help regulate your heart’s rhythm. The pacemaker does not treat AFib, but instead is used to treat a slow heart rate that occurs in some AFib patients. Permanent pacemakers are surgically implanted into the chest. The procedure is considered minor surgery and usually takes about an hour to perform.
It can be difficult to know the exact costs of surgeries and procedures in advance.
Make sure to ask the doctor, hospital or facility how much you’ll have to pay for a service and whether it’s considered an inpatient or outpatient procedure.
Medicare Coverage of Atrial Fibrillation Medications
Medications can be an important part of treatment for many AFib patients.
Drugs are often prescribed to prevent blood clots and reduce your risk of stroke. Your doctor may prescribe additional drugs to control your heart rate and rhythm.
You may receive drug coverage through a standalone Medicare Part D plan or as a bundled benefit included in your Medicare Advantage plan.
But some AFib drugs are costly, even with Medicare.
For example, Eliquis is a popular name-brand drug used to lower the chance of stroke and prevent clots in AFib patients.
There are currently no generic alternatives for Eliquis. So, while most Medicare drug plans provide some coverage, your out-of-pocket costs may still be high.
GoodRx estimates that the average Medicare beneficiary may pay up to $574 for a one-month supply of Eliquis.
People with lower incomes may qualify for a Medicare Extra Help program. In 2021, prescription costs for those who qualify were no more than $3.70 for generic drugs and $9.20 for brand-name covered drugs.
If you don’t qualify for Extra Help, use the online Medicare Plan Finder tool to see if a different drug plan can save you money.
To get the most accurate drug costs when you compare plans, make sure to enter the specific names of your medications, along with dosage and quantity.
The Medicare Plan Finder will give you a comprehensive breakdown of your costs, including plan deductibles, premiums and copayments.
It will also show you which pharmacies participate in each plan and how much it will cost to get your prescriptions filled.
9 Cited Research Articles
- Centers for Disease Control and Prevention. (2020, September 8). Atrial Fibrillation. Retrieved from https://www.cdc.gov/heartdisease/atrial_fibrillation.htm
- Mayo Clinic. (2019, June 25). Atrial fibrillation. Retrieved from https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624
- Cleveland Clinic. (2019, June 17). Atrial Fibrillation (Afib). Retrieved from https://my.clevelandclinic.org/health/diseases/16765-atrial-fibrillation-afib#management-and-treatment
- Freeman, J. V., Wang, Y., Akar, J. et al. (2017, February 1). National Trends in Atrial Fibrillation Hospitalization, Readmission, and Mortality for Medicare Beneficiaries, 1999–2013. Retrieved from https://www.ahajournals.org/doi/full/10.1161/circulationaha.116.022388
- American Heart Association. (n.d.). Atrial Fibrillation Medications. Retrieved from https://www.heart.org/en/health-topics/atrial-fibrillation/treatment-and-prevention-of-atrial-fibrillation/atrial-fibrillation-medications
- American Heart Association. (n.d.). Non-surgical Procedures for Atrial Fibrillation (AFib or AF). Retrieved from https://www.heart.org/en/health-topics/atrial-fibrillation/treatment-and-prevention-of-atrial-fibrillation/nonsurgical-procedures-for-atrial-fibrillation-afib-or-af
- Centers for Medicare & Medicaid Services. (n.d.). Catheter Ablation for Treatment of Atrial Fibrillation. Retrieved from https://www.cms.gov/medicare-coverage-database/details/technology-assessments-details.aspx?TAId=99&bc=AAAEAAAAAAAA
- GoodRx. (n.d.). Eliquis Medicare Coverage. Retrieved from https://www.goodrx.com/eliquis/medicare-coverage
- Medicare.gov. (n.d.). Find your level of Extra Help (Part D). Retrieved from https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/find-your-level-of-extra-help-part-d