Does Medicare Cover a Life Vest Defibrillator?

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Does Medicare Cover a Life Vest Defibrillator?

Medicare: The Basics

Generally, you have two options for Medicare coverage. Medicare Original is solely through the government and doesn’t offer much in the way of “extras.” If you are used to coverage for your dental and vision needs, this might not be the choice for you.

Medicare Planning And ChoicesThe other option, Medicare Advantage, partners with private insurance companies to offer you other “specialty” types of coverage. This option usually costs a bit more, but if you know you are someone who prefers specific doctors or needs a lot of prescriptions for example, this might be the one to explore. Before making a decision, be sure you know what your priorities are, and do your own research to make the choice that’s best for you.

With either plan, the answer to the question of does Medicare cover a life vest defibrillator should be yes–at least for some of the costs.

What is a life vest defibrillator?

According to The American College of Cardiology (ACC), a “life vest defibrillator is a wearable cardioverter defibrillator (WCD) indicated to reduce the risk of sudden cardiac death in patients who are already at risk of cardiac arrest.” Approved by the FDA in 2001 as the only wearable defibrillator, it has garnered some controversy as to whether it is the best choice for those at risk.

According to Zoll Life Vest, the vest has 3 parts. Two of these parts, you wear under your clothes and are not visible to others. One piece, the halter, you wear against your skin. This also contains the electrode belt, which detects any changes or abnormalities to your heart rate–this connects the monitor to the halter. The monitor, the only piece you wear over your clothes keeps track of your pulse and sends the signal for electric pulses if needed.

These parts are not water resistant–the vest can be worn at all times except if you are going to be submerged in water–the shower, bath or if you are swimming.

How does Medicare determine who gets coverage for a defibrillator life vest?

Determining Medicare coverage for anything can be a bit of a headache. There are lots of rules and guidelines whether you are looking for basic coverage, or if you need something special due to a specific condition. Finding out if Medicare covers a life vest defibrillator would definitely qualify as a specific condition. Let’s break it down.

The short and easy answer to the question does Medicare cover a defibrillator vest is yes, but, as per usual, this isn’t the whole story. A lot of the time, although Medicare will cover some of the cost of your vest, they might not cover 100% of the cost of your defibrillator vest.

As with most other specific conditions or equipment, there is a list of qualifying factors that helps to guide you in whether or not you will fall under this qualifying coverage.

Let’s take a look.

Coverage Under Original Medicare

In order to answer the question does Medicare cover a life vest defibrillator, we’ll look at the different plans. If you have coverage under the Original Medicare plan (A and B) then you’re in luck. You might be able to have your defibrillator vest covered 100%. In order to do this, it needs to be both medically necessary and first ordered by your healthcare provider.

Additionally, in order to have 100% coverage, you will need to have a recommendation from a cardiologist. This recommendation needs to clearly says why you are required to wear a life vest defibrillator.

It’s also possible that Medicare A and B will provide temporary coverage while you wait to have a device implanted. You will need to be able to prove at least one of the following criteria in order to qualify for coverage under Medicare A and B:

  • A previous complication with an implanted device
  • A previous myocardial infarction or dilated cardiomyopathy
  • A measured left ventricular ejection fraction less than or equal to 0.35
  • Family history or genetic predisposition to cardiac episodes

Coverage Under Medicare’s Advantage Plan

In most cases, Medicare Parts A and B should cover some of the cost of your life vest defibrillator. But it might depend on a few circumstances. Costs with Part B can become pricey because it doesn’t offer an out-pocket-maximum. So it could become quite costly if you are relying on this. You should check in with your provider for the fine print on this one.

If you have a Medicare Advantage plan then you will already have an out-of-pocket maximum in place. This plan essentially offers you the same amount of coverage while replacing Parts A and B. Your costs will be different depending on your specific plan.

So, does Medicare cover a life vest defibrillator?

Does Medicare cover a life vest defibrillator? I think we have determined that the answer to this question is mostly yes!

If you are in the process of looking for a Medicare plan, keep these things in mind. If may need a life vest defibrillator, you should take this into consider as you are shopping around. Talk with your referring doctor and your cardiologist– if you have one. This might be a helpful step before choosing which plan will best fit your needs.

In the end, if you choose wisely and pay attention to the fine print, things could work in you favor. There’s a chance that you will be able to have your costs covered if you need a life vest defibrillator. If you have other questions about Medicare plans, click here for more information about what’s the best fit for you!

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