Does Medicare Cover Atrial Fibrillation?

Atrial fibrillation — also known as AFib — is an irregular and often rapid heart rate that can lead to severe complications and death.

More than 454,000 people are hospitalized with AFib each year in the United States, and the condition contributes to about 158,000 deaths each year, according to the U.S. Centers for Disease Control and Prevention.

During atrial fibrillation, the two upper chambers of the heart beat irregularly and out of sync with the two lower chambers of the heart.

AFib can be a dangerous and deadly condition. Patients with the disease are twice as likely as patients without AFib to die.

A major concern of people with atrial fibrillation is the potential to develop blood clots within the upper chambers of the heart. This leads to an increased risk of stroke.

According to the U.S. Centers for Medicare & Medicaid Services, or CMS, 5% of AFib patients suffer a stroke each year.

Strokes are even more common among patients with both AFib and heart failure — and these strokes tend to be either fatal or of moderate to high severity in most patients.

Certain factors can increase your risk of developing AFib, including conditions such as obesity, heart disease, sleep apnea, diabetes and high blood pressure.

AFib may be brief, with symptoms that come and go. Or the condition may be persistent and require ongoing treatment.

Atrial fibrillation can be a costly condition to manage because it often requires ongoing treatment, medications, doctor visits and surgery.

According to CMS, the management of AFib and its complications costs the U.S. health care system roughly $26 billion each year.

If you’re a Medicare beneficiary with AFib, your out-of-pocket costs depend on the services you receive, where you receive them and if you have any supplemental insurance, such as Medicaid or a Medigap policy.

If you’re in Original Medicare (Part A and Part B), you can expect a 20% copayment for outpatient services and doctor visits. The $257 Part B deductible for 2025 applies.

If you are admitted to the hospital as an inpatient, you are covered under Medicare Part A, and the $1,676 deductible for 2025 applies.

Copayments, coinsurance and deductibles may differ for beneficiaries enrolled in a Medicare Advantage plan.

Keep in mind that Medicare Advantage plans often restrict you to doctors and providers within the plan’s network. Seeking care outside your network will likely cost more.

If you have AFib, your doctor or health care team will focus on helping you regain a normal heart rhythm, controlling your heart rate and preventing blood clots.

Many options are available to treat AFib, including catheter-based procedures and surgery.

It can be difficult to know the exact costs of surgeries and procedures in advance.

Make sure to ask the doctor, hospital or facility how much you’ll have to pay for a service and whether it’s considered an inpatient or outpatient procedure.

Medications can be an important part of treatment for many AFib patients.

Drugs are often prescribed to prevent blood clots and reduce your risk of stroke. Your doctor may prescribe additional drugs to control your heart rate and rhythm.

You may receive drug coverage through a standalone Medicare Part D plan or as a bundled benefit included in your Medicare Advantage plan.

But some AFib drugs are costly, even with Medicare.

For example, Eliquis is a popular name-brand drug used to lower the chance of stroke and prevent clots in AFib patients.

There are currently no generic alternatives for Eliquis. So, while most Medicare drug plans provide some coverage, your out-of-pocket costs may still be high.

The cash price for a one-month supply of Eliquis is $675 without insurance. Those who have Medicare Part D coverage may have a copay of anywhere between $40 and $170 a month, depending on their plan.

People with lower incomes may qualify for a Medicare Extra Help program. With Medicare Extra Help, beneficiaries may ‌pay as little as $0 on some medications.

If you don’t qualify for Extra Help, use the online Medicare Plan Finder tool to see if a different drug plan can save you money.

To get the most accurate drug costs when you compare plans, make sure to enter the specific names of your medications, along with dosage and quantity.

The Medicare Plan Finder will give you a comprehensive breakdown of your costs, including plan deductibles, premiums and copayments.

It will also show you which pharmacies participate in each plan and how much it will cost to get your prescriptions filled.