Does Medicare Cover Implantable Cardioverter-Defibrillators (ICD)?
An implantable cardioverter-defibrillator (ICD) is a device placed in your chest to monitor an arrhythmia, or irregular heartbeat. It delivers shocks as needed to keep your heart beating properly. Medicare Part A or Part B will cover an ICD depending on whether you receive the surgery to implant the device as an inpatient or outpatient.
What Is an Implantable Cardioverter-Defibrillator?
An implantable cardioverter-defibrillator (ICD) is a small electronic device that connects to the heart to manage and regulate your heartbeat. Your doctor will surgically implant the device into your chest during a minor procedure. The device will send shocks if it detects that you are developing a dangerous irregular heart rate in order to get your rhythm back on track.
According to Harvard Medical School, more than 100,000 Americans get an ICD each year. There are a number of different conditions that might make an ICD advisable.
- You have an abnormal and life-threatening heart rhythm.
- You have had cardiac arrest from ventricular fibrillation.
- You have experienced fainting tied to ventricular tachycardia or ventricular fibrillation.
- You have experienced unexplained fainting.
According to the U.S. National Library of Medicine, most newer ICDs also double as pacemakers, meaning that they can control your heart through electrical pulses to keep it from beating too fast or too slowly, as well as deliver shocks to correct dangerous rhythms.
When Will Medicare Cover an ICD?
Medicare could help cover an ICD and the surgery for it if you have heart failure. It could also potentially be covered if you meet certain other conditions that would make an ICD medically necessary.
- You have experienced cardiac arrest from ventricular fibrillation.
- You have had a heart attack.
- You have severe ischemic dilated cardiomyopathy but not ventricular fibrillation.
- You have severe non-ischemic dilated cardiomyopathy with no history of cardiac arrest or ventricular fibrillation.
- You have a familial or genetic disorder and high risk of life-threatening tachyarrhythmias.
If you have had a heart attack or cardiac arrest from ventricular fibrillation and would like Medicare to cover your ICD, you may be required to meet with your health care provider first to discuss the decision to implant an ICD.
Which Medicare Plans Cover Implantable Defibrillators
ICD surgeries are often an outpatient procedure. If you are an outpatient, Medicare Part B will cover 80 percent of the cost. This leaves you with 20 percent of the cost after the deductible is met if Medicare is paying for the device. You will also have to pay a copayment to the hospital.
But according to the U.S. National Library of Medicine, about 30 percent of ICD implantations occur during acute hospitalizations. If you receive the surgery as an inpatient, then Medicare Part A will cover it. You will be responsible for 20 percent of the cost after you’ve paid the Part A deductible, which is $1,556 in 2022.
A Medicare Advantage plan, or Part C, includes benefits for everything that Original Medicare covers, meaning that an ICD would be covered. Advantage plans vary, but your specific plan could offer additional support for this procedure.
In addition, a Medicare supplement insurance, or Medigap, plan could help with the deductible and coinsurance for an ICD surgery.
10 Cited Research Articles
- U.S. National Library of Medicine. (2021, March 30). Pacemakers and Implantable Defibrillators. Retrieved from https://medlineplus.gov/pacemakersandimplantabledefibrillators.html
- U.S. Centers for Medicare & Medicaid Services. (2021, March 23). CMS Manual System: Pub 100-04 Medicare Claims Processing, Transmittal 10635. Retrieved from https://www.cms.gov/files/document/r10635cp.pdf
- University of Michigan. (2020, August 31). Heart Rhythm Problems: Should I Get an Implantable Cardioverter-Defibrillator (ICD)? Retrieved from https://www.uofmhealth.org/health-library/abk4103
- Harvard Medical School. (2020, June 17). Who Needs an Implantable Cardioverter-Defibrillator? Retrieved from https://www.health.harvard.edu/drugs-and-medications/who-needs-an-implantable-cardioverter-defibrillator
- U.S. Centers for Medicare & Medicaid Services. (2018, February 15). National Coverage Determination (NCD) for Implantable Automatic Defibrillators. Retrieved from https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=110
- National Center for Biotechnology Information. (2017, August 26). Reasons for and Predictors of Acute Hospitalization Versus Elective Outpatient Implantable Cardioverter-Defibrillator Implantation and Subsequent Differential Clinical Outcomes. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28844089/
- Friedman, D.J. et al. (2016, November). Trends and In-Hospital Outcomes Associated With Adoption of the Subcutaneous Implantable Cardioverter Defibrillator in the United States. Retrieved from https://jamanetwork.com/journals/jamacardiology/fullarticle/2549970
- University of Rochester Medical Center. (n.d.) Overview of Pacemakers and Implantable Cardioverter Defibrillators (ICDs). Retrieved from https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=85&contentid=p00234
- U.S. Centers for Medicare & Medicaid Services. (n.d.) Defibrillators. Retrieved from https://www.medicare.gov/coverage/defibrillators
- U.S. Centers for Medicare & Medicaid Services. (n.d.) Medicare Costs at a Glance. Retrieved from https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance