In this Article

Your risk of getting atrial fibrillation (AFib) goes up as you age. It’s also becoming more common. The CDC predicts over 12 million Americans will have it by the year 2030. 

AFib treatment can be costly. A study found it can increase your annual medical costs by more than 70%. But Medicare and Medicaid cover many meds and treatments you need to treat AFib. You may want to find out what you’ll pay out of pocket as you manage your condition. 

Medicaid is a program in your state that uses federal and state tax money to help with your medical costs if you have low income or lack other resources. Requirements can vary from state to state. Medicare is a federal health insurance program that helps with your medical costs if you’re 65 or older, or if you’re younger but have certain disabilities. 

 

 

AFib Care

To diagnose your AFib, your doctor may need to give you tests such as:

  • Electrocardiogram (EKG)
  • Blood tests
  • Holter monitors/event monitors to record your heart activity over time
  • Echocardiogram
  • Stress test
  • Chest X-ray

Treatment for your condition may include:

  • Copays for doctor visits
  • Medications that control heart rate and prevent stroke, such as beta-blockers, calcium channel blockers, digoxin, anti-arrhythmic medications, or blood thinners
  • Cardioversion therapy (done with either drugs or electrodes)
  • Procedures for severe symptoms such as cardiac ablation. Sometimes this can involve open-heart surgery.
     

What Do Medicare and Medicaid Cover?

Almost all treatments for AFib are covered by Medicare and Medicaid. But you might still have costs for copays and other fees. Here’s a closer look: 

If you have Medicare, your coverage will depend, in part, on which part of Medicare you’ve signed up for. 

Part A is hospital insurance and covers your:

  • Hospital stays
  • Medications and procedures you have during your stay
  • Skilled nursing or inpatient rehabilitation facility stays

Part B is medical insurance and covers your:

  • Services from doctors and other health care providers
  • Outpatient care
  • Home health care
  • Medical equipment such as wheelchairs, walkers, or hospital beds 
  • Preventive services such as screenings and wellness visits

Part C is also called Medicare Advantage. A private insurance company provides both Part A and Part B benefits and may also offer you a Part D (prescription drug) benefit. 

Part D is drug coverage and covers the cost of your prescription drugs.

Medicaid. You can have Medicaid by itself or in addition to Medicare. But to qualify for Medicaid, you have to meet your state’s rules. In general, Medicaid covers your:

  • Medicare Part B monthly premiums
  • Share of Medicare costs such as deductibles, coinsurance, and copayments
  • Part A premiums (for some people with low income)

You’ll also get a service called Extra Help for your drug costs. And Medicaid may pay for some drugs and services that Medicare doesn't cover.

Specific Coverages

Communication with your doctor is key, as they may have to certify that your AFib treatments are medically necessary for your plan to approve their costs. Here are some parts of AFib treatment and how they’re usually covered:

Cardiologist visits to check the status of your AFib are covered by Medicare Part B or Part C. You’ll be responsible for copays for these doctor’s visits.

Diagnostic tests such as ECG and Holter monitors are covered by Medicare Part B.

Cardiovascular behavioral therapy that helps lower your risk for cardiovascular disease is covered by Medicare Part B and Medicaid.

AFib meds such as beta-blockers, calcium channel blockers, antiarrhythmic agents, and blood thinners are covered by Medicare Advantage and Part D plans.

Cardioversion is covered by Medicare Part A and Medicaid. 

Catheter and surgical ablation and pacemaker procedures are both covered by Medicare Part A and Medicaid. 

What You’ll Pay

Your out-of-pocket costs for some Afib-related procedures and treatments will depend on where they’re done and other things. 

You can call ahead and get more information about what you’re responsible for with these tips:

  • Visit Medicare’s price lookup page to see what the average cost for your procedure is in different settings. 
  • Ask your doctor, surgeon, or health care provider how much the surgery or procedure will cost. Don’t forget the price of any care and services you’ll need after the procedure is over. 
  • If you have a procedure or hospital stay coming up, see if you’ve already met your deductible for Medicare Parts A or B. You can find this by looking at your last “Medicare Summary Notice.” You’re responsible for paying any deductible amounts before Medicare will start to pay. After Medicare starts to pay, you might still have copays for some of your care.
  • Call the hospital or facility and ask them for a predicted cost for the specific procedure you’re having.

© 2023 WebMD, LLC. All rights reserved.

Show Sources

SOURCES: 

American Heart Association: “Who is at Risk for Atrial Fibrillation (AF or AFib)?”

CDC: “Atrial Fibrillation.”

Mayo Clinic: “Atrial Fibrillation.”

Medicare.gov: “Parts of Medicare,” “Medicaid,” “Learning What Medicare Covers & Your Costs.”

U.S. Department of Health and Human Services: “Intensive Behavioral Therapy for Cardiovascular Disease.”

Centers for Medicare and Medicaid Services: “Atrial Fibrillation Disparities in Medicare Fee-For-Service Beneficiaries.”

Heart Rhythm Society: “Catheter Ablation Shown to be Cost-Effective for Patients in Need of Treatment for Irregular Heart Beats.”