Does Medicare Cover Implantable Defibrillators?

Pamela Cannaday by Pamela Cannaday | Licensed since 2011
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This article was updated on: 09/10/2018

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If you have certain heart conditions, your doctor may recommend you have an implantable cardiac defibrillator, or ICD. Your Original Medicare (Part A and Part B) may cover an implantable defibrillator if your doctor believes it is medically necessary to treat your condition, as long as you meet certain eligibility requirements.

What is an implantable defibrillator?

According to the National Heart, Lung, and Blood Institute (NHLBI), an implantable defibrillator can prevent sudden death from cardiac arrest (when the heart suddenly stops beating) in patients that have certain heart conditions. Typically, doctors might recommend an ICD if you have a certain type of arrhythmia, which is a problem with the heartbeat’s rhythm or regularity.

ICDs are battery-powered devices implanted under the skin in the chest or abdomen, according to the NHLBI. Equipped with wires (called leads) that detect heartbeat rhythms, an ICD can deliver a shock to restore a normal rhythm. ICDs often have built-in pacemakers that can prevent bradycardia (a dangerously slow heartbeat), the American Heart Association reports.

Is an implantable defibrillator different from a pacemaker?

Both devices are usually placed under the skin with electrodes attached to the heart, says the National Heart, Lung, and Blood Institute (NHLBI) website. Both types of device are capable of delivering low-energy shocks to the heart if an arrhythmia is detected. An implantable cardiac defibrillator (ICD), however, can also deliver a high-intensity shock that actually jolts the heart out of a certain type of life-threatening arrhythmia.

Many implantable defibrillators also function as pacemakers, but pacemakers are not capable of defibrillating the heart. If you have ever had a cardiac arrest, your health-care team may have used paddles to your chest to shock your heart back to normal rhythm. An implantable cardiac defibrillator (ICD) does the same thing inside your body when life-saving treatment isn’t immediately available.

What Medicare coverage is available for an implantable defibrillator?

Medicare coverage may be available for implantable automatic defibrillators (ICD) if ordered by your doctor for certain heart conditions. How Medicare coverage works depends on whether you undergo the implantation procedure as an inpatient or an outpatient.

Under Original Medicare, your Part A benefits cover care you receive as an inpatient in the hospital; therefore, if you’ve been admitted as a hospital inpatient when the device is implanted, Part A generally covers allowable charges after you’ve paid the Part A annual deductible.

If you have the device implanted as an outpatient in the hospital, Part B usually covers the procedure, but in most cases you will pay a hospital copayment, as well. The copayment cannot be more than your Part A deductible for a hospital stay, however.

The Medicare Advantage program, also called Medicare Part C, offers beneficiaries an alternative way to receive their Medicare benefits. These plans, which must cover everything covered in Original Medicare, Part A and Part B (except for hospice care, which is still covered by Part A), often include prescription drug benefits and sometimes even coverage for wellness programs to help with cardiac rehabilitation after a heart attack or surgery to place an implantable defibrillator.

Understanding your options for Medicare coverage after a life-threatening cardiac event can be the first step toward peace of mind; I’d like to answer any questions you may have. You can schedule a phone call or request an email with more information by clicking one of the links below. The “Compare plans” button shows you a list of plans you may qualify for in your area.

 

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