Medicare and ablation

Hi everyone

Does Medicare cover ablation as a first line for paroxysmal AFIB or do we have to “fail” some anti arrhythmic drugs first?

Thanks

Brian

Yes, Medicare covers ablations as first line therapy. Ablation is now widely accepted as first line therapy by pretty much everyone.

I live in NC and my upcoming visit to Austin, Dr Natale is 100% covered
Im 67, so my outa pocket is airfare hotel ubers etc

Surely Medicare must stipulate something. For example, afib burden, symptomatic, etc.. So if your local EP writes an ablation referral to someone who takes the case, that is all that is required?

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safib
Surely Medicare must stipulate something.

Sure, a diagnosis of afib. Ablation is an accepted first line treatment so why would they quibble about details like burden? A single ECG would be sufficient proof of the diagnosis.

The biggest issue someone with Medicare can run into is the 20% Medicare does not pay. If you have Medigap, you should be fine. If you have a Medicare Advantage plan, you could have issues if you do not live in Texas. Medicare Advantage generally works with the state Hospitals and facilities.
Medigap is a Medicare supplement that will cover your out of state Medicare Deductible.
Make sure your Supplement plan for Medicare will work for you out of state. Generally, Medicare Advantage plans are much cheaper but most only cover the Hospitals in your Home State you reside in and generally even then not all Hospitals are covered.

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smackman
Generally, Medicare Advantage plans are much cheaper but most only cover the Hospitals in your Home State you reside in and generally even then not all Hospitals are covered.

It's even more restrictive than that. Advantage plans are basically HMOs and you can only use the hospitals and providers in their network. You won't even have the option of going out of network and having them pay less. They will pay nothing if you go out of network. So it's quite likely if there are 25 hospitals in your state and you have an Advantage plan, you can only use 2-3 of them, or possibly even just one.

I was told that I had to try various drugs first. So, it is NOT first line for me anyway.

There are some Medicare Advantage plans that do cover out of state care. I have UnitedHealthcare Medicare Advantage Choice Plan 1 (Regional PPO), live in NY, and had it cover 2 Natale ablations in Austin and just paid a copay each time.

From their description:
This PPO plan gives you freedom to see any provider nationwide that accepts Medicare plus access to network costs when you see doctors participating in the UnitedHealthcare® Medicare National Network.

Monthly Premium: $16.

United Healthcare Medicare Advantage Choice Plan 1

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Jaydee212
I was told that I had to try various drugs first. So, it is NOT first line for me anyway.

When was this and are you sure it was coming from Medicare?

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Carey

I was told that I had to try various drugs first. So, it is NOT first line for me anyway.

When was this and are you sure it was coming from Medicare?

I really want to hear this answer. It is so important to know what your will cover. One can get “ burned” really easily by a contractor who’s goal is to sell you a plan BUT you find out the hard way that only certain Hospitals will cover your procedure in the STATE you reside in.
I have a Medigap plan and it cost me approximately $310 a month for Medicare Part N . I am 63 years old snd this plan currently will drop to less than $100 a month when I turn 65. Bcbs is killing me because I am not 65. I am disabled and they Jack up the supplement price over this. At age 65, the price droops to the “ normal” price per month. It stinks but I keep it because I “ might” need Austin before February 2023.

Indeed, there are Medicare Advantage plans which cover 'out of area'. Knowing that I would be traveling/living different locals extensively, I chose an Aetna Medicare Plan (PPO) "out of area value plan". I have found it to be extremely flexible, having been treated everywhere I have had to go with full coverage. For instance I could have had ablations in SLC, Cleveland Clinic, Austin (final choice!) though I live in Idaho.