Pacemaker Costs with Medicare
- Pacemakers are devices that help regulate heart activity. Medicare may cover pacemaker costs if recipients meet certain criteria. Keep reading to learn more.
In most cases, Medicare Part B covers 80% of the cost for durable medical equipment, including pacemakers. Medicare recipients are generally required to pay approximately 20% of the costs of DME.
Original Medicare (Part A and Part B) typically covers pacemaker implants, though you'll likely be required to pay potentially high coinsurance, copays and/or deductible costs. A type of insurance plan called a Medicare Supplement (also called Medigap) plan can help pay for these out-of-pocket Medicare costs.
Does Medicare Cover Pacemaker Procedures?
In general, Medicare does cover pacemaker procedures when they're considered medically necessary.
- Medicare Part A typically covers inpatient implantable automatic defibrillator procedures when recipients are treated in hospital settings and placed under local anesthesia.
Single overnight hospital stays may fall into the outpatient category, so recipients should always consult with their specific plans to determine whether their pacemaker procedures are covered under Part A or Part B.
- Medicare Part B typically helps cover the costs of outpatient procedures and equipment when considered medically necessary. Pacemakers covered by insurance are categorized as durable medical equipment/prosthetic devices under Part B.
- Medicare Part C plans (Medicare Advantage) are sold by private insurance companies and are required to cover the same services as procedures as Medicare Part A and Part B. This means that, in most cases, both pacemaker placement procedures and equipment should be covered under Medicare Part C, but it's important for recipients to consult with their insurers to verify coverage.
Many Medicare Advantage plans offer additional benefits Original Medicare doesn't cover, such as prescription drugs, dental, hearing, vision, fitness memberships and other potential benefits.
It's important to note that Medicare Advantage and Medicare Supplement are very different, and you can't have both types of plans at the same time.
In some cases, individuals who undergo pacemaker implantation procedures are prescribed anti-arrhythmic and beta blocker medications. These medications should usually be covered under Medicare Part D (prescription drug coverage).
Does Medicare Cover Replacement Pacemakers?
When deemed medically necessary, Medicare typically provides coverage for battery replacement in single- and dual-chamber pacemakers.
While pacemaker batteries are designed to last between 5 and 7 years, there are certain situations in which the batteries may fail or a complete equipment replacement is necessary. In these cases, Medicare may allow for early replacement of both batteries and equipment.
What Are the Three Types of Pacemakers?
The three types of pacemakers are single-chamber pacemakers, dual-chamber pacemakers and biventricular pacemakers. The type of pacemaker recommended depends on an individual's specific condition.
- Single-chamber pacemaker: A single-chamber pacemaker connects to the heart via a single lead, most often through the right ventricle. Single-chamber pacemakers are often utilized to help control abnormal heart rhythms.
- Dual-chamber pacemaker: Dual-chamber pacemakers connect to both right-sided chambers in the heart via two leads. Dual-chamber pacemakers are typically placed to assist the heart in regulating contractions.
- Biventricular pacemaker: Biventricular pacemakers connect to the heart chambers via three leads. Biventricular pacemaker placement is generally recommended to help regulate arrhythmias caused by advanced heart failure.
What Are the Different Types of Pacemaker Procedures?
Pacemakers can be placed surgically, inserted through the veins or via catheters. During a pacemaker surgical procedure, a surgeon makes small incisions in the chest area and inserts small wires or leads through the incisions.
The leads are attached directly to the heart and transmit electrical impulses via the pacemaker device. Once the leads are attached to the heart and pacemaker, the surgeon places the pacemaker beneath a pocket of skin on the abdomen.
During a transvenous (through the vein) procedure, leads are threaded through a vein close to the heart and attached to the heart and the pacemaker. After attachment of the wires, the surgeon inserts the pacemaker beneath a pocket of skin on the chest.
Catheter-based pacemaker placement is typically recommended for conditions that affect single heart chambers. During the procedure, a long tube is inserted into an artery and directly attached to the heart wall.
What Medical Conditions Qualify Someone for a Pacemaker?
Pacemaker placement is often recommended for individuals with medical conditions that cause the heart to beat irregularly or abnormally. Some common conditions include:
- Slow heartbeat following a heart attack
- Heart failure
- Slow heartbeat following surgery or medication overdose
- Fainting spells
- Hypertrophic cardiomyopathy (thickened heart muscle)
Learn more about Medicare Supplement insurance and find out if a Medigap plan in your area could help cover the out-of-pocket Medicare costs you'll face when getting a pacemaker.