Cardiac arrest is a serious and sometimes fatal condition that needs to be treated right away. There are many causes of cardiac arrest including high cholesterol, heart disease, diabetes, and more. And there are also certain treatments for it, one of which is a life vest defibrillator.
If you would like to get one of these devices, it is common to want to know “does Medicare cover life vest defibrillators?” In this article, we answer that question in clear, plain English. You will also find the average costs of going to a life vest defibrillator and other helpful info.
Does Medicare Cover Life Vest Defibrillators?
The short answer is yes; Medicare will cover the cost of a life vest defibrillator. 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 life vest defibrillator. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for life vest defibrillators such as the Zoll LifeVest. Parts A and B provide coverage for your life vest defibrillator if it is considered medically necessary. It must also be first ordered by your healthcare provider for Original Medicare to provide coverage.
For Original Medicare to provide coverage, you will also need the recommendation of a cardiologist. You will also need to provide clear documentation that states why it is medically necessary for you to have a life vest defibrillator.
Original Medicare may only provide coverage for life vest defibrillators for temporary use only. Parts A and B will provide coverage for the life vest defibrillator temporarily while the patient waits for an implantable device.
You have to meet at least one of the following criteria to get coverage:
- You have a high risk of having a cardiac episode due to genetics / family history.
- A mechanical complication with a previously implanted defibrillator.
- An episode of ventricular fibrillation or a sustained ventricular tachyarrhythmia that lasts 30 seconds or more.
- A previous myocardial infarction or dilated cardiomyopathy (and a measured left ventricular ejection fraction less than or equal to 0.35
Original Medicare also provides coverage for an implantable automatic defibrillator. Original Medicare provides coverage for an implantable automatic defibrillator if the patient is diagnosed with heart failure.
Coverage for an implantable automatic defibrillator is provided by Medicare Part A if it takes place in an inpatient setting.
On the other hand, coverage for an implantable automatic defibrillator is provided by Medicare Part B when it takes place in an outpatient setting.
Part C Coverage for Life Vest Defibrillator
Medicare Advantage plans (Medicare Part C) also provide coverage for life vest defibrillators. These plans must cover the same devices, treatments and services that Original Medicare does. But these plans will also cover some things that Original Medicare does not. The specifics of what additional coverage a plan offers and what the costs are will depend on the plan.
How Much Does A Life Vest Defibrillator Cost?
A life vest defibrillator may cost around $3,000 a month if you do now have insurance coverage. This cost is unlikely to vary greatly.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. 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 a vasectomy?