Original Medicare and Medicare Advantage plans both help people pay atrial fibrillation (A-fib) costs. However, out-of-pocket amounts may differ.
A-fib occurs when a person’s heart is beating too fast, too slow, or in an irregular way. It may happen occasionally, or it may be permanent. The condition can lead to cardiac problems, including stroke and blood clots.
This article describes A-fib and examines Medicare coverage, treatment options, and costs. It also looks at financial aid options.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
A-fib is an irregular heartbeat. It is a type of arrhythmia.
According to the Centers for Disease Control and Prevention (CDC), by 2030, more than 12 million people in the United States will have A-fib.
The human heart has four chambers. The two upper chambers are called atria, and the two lower chambers are called ventricles.
In a healthy heart, the atria beat regularly and help blood flow to the ventricles. However, if a person has A-fib, it means that the atria are beating irregularly, which impedes blood flow.
A-fib is less common in men, partly because women may live longer, and it is also less common in African American people than in people of European descent, according to the CDC.
A person with A-fib may have no symptoms, or they may have them only intermittently.
If symptoms do occur, they may include:
Medicare covers treatment and medication for A-fib, providing a doctor deems them medically necessary.
There are four parts to Medicare. These are as follows:
- Original Medicare (Part A and Part B) offers hospital and medical insurance.
- Part C, also known as Medicare Advantage, offers an alternative to original Medicare.
- Part D is coverage for prescription drugs.
Medicare Part A
Part A provides cover for inpatient stays in a hospital, clinic, or skilled nursing facility. It also covers prescription drugs, such as blood thinners, while a person is an inpatient.
Medicare Part A also covers:
- catheter and surgical ablation
- pacemaker placement
- electrical or chemical cardioversion
Medicare Part B
Part B is medical insurance that covers outpatient services. This includes doctor’s visits, diagnostic exams, and screenings, including a one-time screening electrocardiogram.
Part B also covers cardiovascular disease screenings every 5 years — to test a person’s cholesterol, lipid, and triglyceride levels — and cardiac rehabilitation programs.
Medicare Part C
Private insurance companies offer Part C, or Medicare Advantage, plans. These all-in-one plans provide the same benefits as original Medicare parts A and B, and they may also offer additional benefits, such as prescription drug coverage, vision, hearing, and dental services.
Medicare Part C covers the same A-fib treatments as original Medicare and may help people with healthy lifestyle programs. Part C also generally covers regular prescription medications for the treatment of A-fib.
Medicare Part D
Private insurance companies offer Medicare Part D plans that cover prescription medications. A person can check with their plan provider to find out if it includes their prescription.
Most Part D plans include A-fib-related medication.
Medicare covers most of the cost of A-fib treatment. However, a person will have out-of-pocket expenses, including:
- Part A deductible of $1,484 per benefit period
- Part B deductible of $203
- Part B premium of $148.50 per month
- 20% of the Medicare-approved amount for physician services
Medicare Advantage costs
Those enrolled in a Medicare Advantage plan will pay a premium for Medicare Part B plus their Advantage plan premiums.
The average monthly premium for an Advantage plan that includes drug coverage is $36 in 2020.
Part D costs
If a person has a Part D prescription drug coverage plan, the base premium in 2021 is $33.06, though the total premium varies by location and plan. Other costs may include deductibles, copays, and coinsurance.
Medicaid and Medigap may help people pay healthcare costs.
The following sections look at these in more detail.
Medicaid is a government program that helps low income households access healthcare services. People must meet specific eligibility criteria to qualify. Each state administers Medicaid differently, but all states consider the household’s income and assets.
Medigap is supplementary insurance that helps people pay for some out-of-pocket expenses that Medicare does not cover. Private insurance companies offer a range of 10 plans with different levels of cover.
Medigap can cover copays, deductibles, and coinsurance. It may also cover medical treatment while someone travels outside of the U.S. Plans do not cover dental, vision, or hearing care, however.
There are several health issues associated with A-fib, some of which may be life threatening.
The following sections look at these possible complications in more detail.
If the heart is not beating regularly, it means that blood flow is compromised, and blood clots may develop. If part of the blood clot, or an embolus, breaks off, it may travel to other parts of the body and create a blockage. This may be fatal.
If an embolus completely or partially blocks a brain artery, it means that blood cannot reach the brain or has a reduced flow. This could result in a stroke.
Every 4 minutes in the U.S., a person dies due to a stroke.
A-fib can lead to heart failure, especially when the heart rate is high. It can also worsen the symptoms of any underlying heart failure.
Treatment to improve A-fib symptoms and reduce the risk of complications may initially include medications, though surgery may also be necessary.
The following sections look at the treatment options in more detail.
Initially, a doctor may prescribe medication to help control a person’s heart rate and prevent blood clots from forming.
Depending on the outcome, a doctor may recommend other medications or a surgical procedure to regulate the heartbeat.
A doctor may prescribe anticoagulant medications, or blood thinners, to decrease the risk of blood clots forming. These medications include warfarin and direct-acting oral anticoagulants.
Managing heart rate
If an individual has a high heart rate, a doctor may prescribe medications that slow the heart’s electrical signals. These include:
- calcium channel blockers
A doctor may try to regulate a person’s heart rhythm by using pharmacologic or chemical cardioversion.
A person can receive antiarrhythmic medications orally or through an intravenous line, and the procedure may take place in a hospital, clinic, or the person’s home.
The medication generally depends on the type of arrhythmia a person has, and it may include flecainide, propafenone, or verapamil.
Typically, a cardiologist will follow up with the person to check their heart rate and rhythm.
If a person’s condition does not respond to medication, a doctor may recommend a surgical or nonsurgical procedure.
The following sections look at some possible procedures in more detail.
In this procedure, a healthcare professional will use an electric shock to try to reset the heart’s rhythm.
They will perform an echocardiogram before the procedure to check that there are no blood clots. If there is a blood clot, they will advise the person to take anticoagulant medication to dissolve the clot before the procedure can take place.
During catheter ablation, a healthcare professional will thread a flexible tube, or catheter, to the heart through a vein or artery in a person’s groin.
The catheter will deliver heat or cold energy, which destroys the cardiac tissue that triggered the abnormal rhythm.
Surgical ablation, or a maze procedure, is an alternative to catheter ablation. A healthcare professional will remove the tissue causing the irregular rhythm during open heart surgery.
A pacemaker can regulate a person’s heartbeat. A healthcare professional may offer one as an option to a person with A-fib.
If a doctor deems the treatment medically necessary, Medicare will cover the cost of A-fib. Original Medicare and Medicare Advantage plans both cover the cost of procedures to treat A-fib. If a person needs regular medication, a Medicare Advantage plan may cover the cost.
A-fib is a type of arrhythmia. Doctors may use prescription medications or surgical or nonsurgical procedures to treat this condition.
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