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Atrial fibrillation, also known as AFib, is a dangerous heart disorder that affects around 2.7 million individuals in the United States. It can lead to a stroke or blood clots in the heart by causing an abnormal heart rhythm.
Ablation of the heart is a minimally invasive operation that “maps” the heart’s electrical activity. This map is used by a specialist physician known as an electrophysiologist to “burn” or ablate areas where abnormal electrical activity originates.
If this is an issue you or a loved one are experiencing, a common question many people have is, “Does Medicare cover Ablation for AFib?”
In this article, we answer the question in clear, plain English. You will also find the average costs of going through ablation for AFib and other helpful info.
Does Medicare Cover Ablation For AFib?
The short answer is yes; Medicare will cover the cost of ablation for AFib. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your ablation for AFib. Below we look at what these are so you know what to expect.
Medicare Part A and Part B
Original Medicare (Medicare Part A and Part B) provides coverage for ablation for AFib and other treatments for AFib. Original Medicare provides coverage for some treatments for AFib but not all of them. Among those, Original Medicare covers ablation for AFib.
Original Medicare provides coverage for ablation for AFib if it is considered medically necessary. Your healthcare provider must first order the procedure for Original Medicare to provide coverage.
Coverage for ablation for AFib is provided by Medicare Part A if your ablation for AFib takes place in an inpatient setting. Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days.
On the other hand, most of the time. Coverage for ablation for AFib is provided by Medicare Part B. It often takes place in an outpatient setting. Once approved, Medicare Part B covers 80 percent of the costs of ablation for AFib. You will pay for the remaining 20 percent.
Medicare Part C
Medicare Advantage plans (Medicare Part C) also provide coverage for ablation for AFib. These plans must cover everything Original Medicare covers but will also provide additional benefits not included with Plan A or B.
What these plans cover, and how much they cost, will depend on where you live and the plan you get.
How Much Does Ablation For AFib Cost?
The median cost of catheter ablation is around $33,000. However, the exact cost of your ablation will depend on certain factors, such as your location and insurance.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always be sure to double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series, including: Does Medicare Cover UVB Light Therapy?