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.
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Christian Simmons is a writer for RetireGuide and a member of the Association for Financial Counseling & Planning Education (AFCPE®). He covers Medicare and important retirement topics. Christian is a former winner of a Florida Society of News Editors journalism contest and has written professionally since 2016.Read More
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- Published: June 22, 2021
- Updated: January 10, 2023
- 4 min read time
- This page features 13 Cited Research Articles
- Edited By
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 Coverage of Pacemakers
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 Coverage of Pacemakers
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 Coverage of Pacemakers
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 Coverage of Pacemakers
Medicare Part D, provided by private insurers, will only cover any prescription medication after a pacemaker surgery.
Does Medicare Cover Pacemaker Replacements?
Original Medicare will cover battery replacements in single and dual chamber pacemakers if it’s medically necessary. According to Hopkins Medicine, most device batteries will typically last 5 to 7 years. However, if your pacemaker experiences poor performance, premature failures or medically necessary upgrades, then Medicare will replace your equipment early.
If you have Part B, then you are only responsible for paying 20% of the cost, assuming you have met your Part B deductible. If you are lower income, then you may qualify for the Medicare Savings Program which can help pay for premiums, deductibles, coinsurance and copayments.
It’s important to check with your doctor to see when your pacemaker battery expires or to determine when it may be medically necessary to replace it. The performance of a pacemaker may depend on the person or quality of device.
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.
Wanted information about the possibility, procedure and cost. All of this was covered in this article.
13 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/pacemakers
- National Center for Biotechnology Information. (2018, April). Leadless pacemakers: a contemporary review. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5997619/
- John Hopkins Medicine. (n.d.). Retrieved from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/frequently-asked-questions-about-pacemakers-and-implantable-cardioverter-defibrillators-icds
- 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/view/ncd.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
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