Does Medicare Cover Pacemakers?
Pacemakers are covered by Medicare if they are considered medically necessary. These medical devices are surgically implanted in your chest and send electrical pulses to your heart to keep it from beating abnormally. According to the U.S. National Library of Medicine, around 200,000 Americans get a pacemaker every year.
Medicare Coverage of Pacemakers
Medicare will cover the surgery and implantation of a pacemaker if you have a severe condition – like non-reversible bradycardia or any other serious ailment – that can cause an irregular heartbeat.
The parts of Medicare all play distinct roles in the coverage of a pacemaker.
Medicare Part A
Medicare Part A will cover your surgery and hospital stay if you are an inpatient when you receive your pacemaker.
Pacemaker implantation occurs while you are under local anesthesia and may require a brief hospital stay. However, it’s important to note that you are not automatically an inpatient if you stay overnight in a hospital.
Check with your doctor or healthcare provider to determine your status.
Medicare Part B
Medicare Part B, which with Part A makes up Original Medicare, is used to pay for outpatient services and medical equipment. Pacemakers are covered under Part B because they are considered durable medical equipment (DME) as a prosthetic device.
For most DME, Medicare will cover 80 percent of the cost. After the Part B deductible has been met, you’d pay 20 percent coinsurance.
Medicare Part C
Medicare Part C, or Medicare Advantage, is an alternative to Original Medicare and is provided by private insurers. Part C includes everything covered under Parts A and B, as well as additional benefits and coverage.
Check with your plan to determine what expanded coverage could be available for pacemaker surgery, recovery or related services.
Medicare Part D
Medicare Part D, provided by private insurers, will only cover any prescription medication after a pacemaker surgery.
What Is a Pacemaker?
A pacemaker is a battery-powered device that is surgically implanted in your chest to manage an arrhythmia. The device sends electrical pulses into your heart to keep it beating at the right pace.
Pacemakers typically weigh as little as an ounce.
- Single-Chamber Pacemaker
- This type includes one lead connected to your heart, usually the right ventricle, to control its rhythm.
- Dual-Chamber Pacemaker
- This device consists of two leads connected to both right-sided chambers of your heart to regulate contractions.
- Biventricular Pacemaker
- This type connects three leads to your heart and is used for arrhythmias developed from advanced heart failure.
Pacemakers differ from implantable cardioverter defibrillators (ICDs) in that a pacemaker provides electric stimuli. Yet, an ICD monitors heart rate and will deliver an electric shock if it detects a life-threatening rhythm developing.
According to the U.S. National Library of Medicine, newer ICDs can also double as pacemakers. Check with your doctor or healthcare provider about which device you need.
Other Cardiovascular Options Covered by Medicare
Suppose you have recently had a heart attack or undergone a serious procedure related to your heart, like a coronary artery bypass or a heart transplant. In that case, Medicare Part B will cover cardiac rehabilitation programs. These services include exercise as well as counseling.
Medicare will also cover cardiovascular disease screening blood tests once every five years at no cost. Also, as mentioned earlier, implantable cardioverter defibrillators are covered if they are medically necessary.
12 Cited Research Articles
- U.S. National Library of Medicine. (2021, May 4). Heart pacemaker. Retrieved from https://medlineplus.gov/ency/article/007369.htm
- U.S. National Library of Medicine. (2021, March 30). Pacemakers and Implantable Defibrillators. Retrieved from https://medlineplus.gov/pacemakersandimplantabledefibrillators.html
- U.S. Department of Health and Human Services. (2021, January 8). Pacemakers. Retrieved from https://www.nhlbi.nih.gov/health-topics/pacemakers
- National Center for Biotechnology Information. (2018, April). Leadless pacemakers: a contemporary review. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5997619/#:~:text=Over%20one%20million%20cardiac%20pacemakers,numbers%20are%20expected%20to%20grow.
- Stanford Health Care (n.d.). Our Approach for Pacemakers. Retrieved from https://stanfordhealthcare.org/medical-treatments/p/pacemaker/types.html
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Cardiac rehabilitation. Retrieved from https://www.medicare.gov/coverage/cardiac-rehabilitation
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Cardiovascular disease screenings. Retrieved from https://www.medicare.gov/coverage/cardiovascular-disease-screenings
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Coverage Issues – Durable Medical Equipment. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/pub06_part_60.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Defibrillators. Retrieved from https://www.medicare.gov/coverage/defibrillators
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Durable medical equipment (DME) coverage. Retrieved from https://www.medicare.gov/coverage/durable-medical-equipment-dme-coverage
- U.S. Centers for Medicare & Medicaid Services. (n.d.). National Coverage Determination (NCD) for Cardiac Pacemakers: Single Chamber and Dual Chamber Permanent Cardiac Pacemakers. Retrieved from https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=357
- U.S. Centers for Medicare & Medicaid Services. (n.d.). What Part A covers. Retrieved from https://www.medicare.gov/what-medicare-covers/what-part-a-covers