Does Medicare cover cardiac ablation?
Living with atrial fibrillation can be scary. Its symptoms can impact your daily life. Atrial fibrillation, also called AFib, is the most common type of heart arrhythmia. 9% of people in the United States aged 65 and older have AFib. If you’re one of these people with AFib, you may experience heart palpitations, fatigue, and dizziness. People with AFib also have an increased risk of stroke. Managing your irregular heartbeat involves medications, lifestyle changes, and medical procedures, like cardiac ablation.
Fortunately, Medicare helps pay for the cost of services to treat AFib, including cardiac ablation. In this post, we'll discuss how much you'd pay out of pocket for cardiac ablation and other treatment options for AFib that Medicare covers.
Key takeaways:
Cardiac ablation is a treatment option for people with atrial fibrillation.
Original Medicare covers cardiac ablation and AFib diagnostic exams.
Medicare Advantage provides the same coverage as Original Medicare, but out-of-pocket costs vary between different plans and carriers.
Your prescription drug plan can cover any medications for AFib and follow-up care following cardiac ablation.
What is cardiac ablation?
Cardiac ablation is a medical procedure used to treat AFib and other arrhythmias. Normally, your doctor will recommend cardiac ablation if other treatments for AFib aren't effective. Cardiac ablation eases symptoms of AFib, like heart palpitations, dizziness, fatigue, and fainting.
There are two types of cardiac ablation:
Catheter ablation
Surgical ablation
Catheter ablation
Doctors use thin tubes called catheters that go through blood vessels to reach the heart. These tubes deliver energy, such as heat or cold sources, to small areas in the heart that cause irregular heartbeats. This energy helps make the heart beat at a normal pace again.
Surgical ablation
Surgical ablation is a more complex procedure. Unlike catheter ablation, a surgical ablation involves open-heart surgery or minimally invasive techniques to directly access the heart. The surgeon creates scars on the heart with energy from heat or cold sources to help normalize your heartbeat.
Does Medicare cover cardiac ablation?
Yes, Medicare covers cardiac ablation. Different parts of Original Medicare cover various services for people with AFib. Medicare Advantage plans also cover the procedure, but out-of-pocket costs vary between policies. If you have a prescription drug plan (Part D), it should cover the medications you need following the procedure. Just check your drug plan's list of covered drugs to confirm coverage.
Part A
Part A generally covers any inpatient procedures provided in a hospital setting. Part A also covers catheter and surgical ablation. While Part A is premium-free for most Medicare beneficiaries, you’ll be responsible for out-of-pocket costs. You can learn about Medicare Part A and its costs here.
Part B
Before your doctor recommends cardiac ablation, you'll undergo diagnostic tests and screenings, including an electrocardiogram, to diagnose AFib. Part B covers 100% of the costs of preventative exams.
Medicare Advantage (Part C)
Every Medicare Advantage plan has to cover the same services as Original Medicare. However, your out-of-pocket costs depend entirely on what plan you have. With Medicare Advantage, you may also need to get prior authorization to ensure coverage. Check with your insurance carrier for a better expectation of how much you'd pay for a cardiac ablation procedure.
Part D (prescription drug plans)
If you do get a cardiac ablation, you may need pain medication for healing and recovery. Your prescription drug plan is responsible for covering the prescriptions you need after treatment. Most Part D plans also provide coverage for AFib medications.
Other treatment options for AFib
Doctors will usually recommend cardiac ablation only if other methods don't work first. Treatment options for AFib include:
Medications:
Antiarrhythmics and rate control medications help restore and maintain a normal heart rhythm.
Anticoagulants:
People with AFib are at higher risk of blood clots and stroke. Anticoagulants are blood thinners that reduce the likelihood of these risks.
Cardioversion:
Electrical cardioversion uses a controlled electric shock to restore a normal heart rhythm, which can be done either in an emergency or as a planned procedure.
Implantable devices:
Pacemakers are implanted devices that help regulate the heart's rhythm by sending electrical impulses to the heart.
Implantable Cardioverter Defibrillators (ICDs) monitor heart rhythm and deliver shocks to restore a normal rhythm if the implanted device detects a life-threatening arrhythmia.
Lifestyle modifications:
You can also manage AFib with lifestyle modifications such as limiting alcohol and caffeine intake. Healthcare providers will also recommend that you quit smoking.
Medicare helps people pay for these AFib services, but out-of-pocket charges will depend on the service or procedure you need. It's always a good idea to communicate with your healthcare provider’s billing department and insurance carrier to get an estimate for how much you'd pay.
Everyone's treatment plan for AFib differs, and your healthcare provider will recommend the best option for you based on your health history. Questions about how Medicare covers cardiac ablation and other AFib-related procedures are common. Get them all answered with the help of a licensed and trusted Medicare Advisor—call us at 855-900-2427 or schedule a time to talk in advance today.