Medicare may cover pacemaker costs if the pacemaker is medically necessary and appropriate for a person’s treatment.
The part of Medicare that covers pacemakers and their related costs will vary depending on the setting and service type.
Read on to learn more about Medicare coverage for pacemakers and other help with pacemaker costs.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
![An x-ray showing a pacemaker, which may be covered under Medicare](http://i0.wp.com/post.brandandgeneric.com/wp-content/uploads/sites/3/2020/10/GettyImages-1013707860_header-1024x575.jpg?w=1155&h=1528)
The Centers for Medicare and Medicaid Services covers cardiac pacemakers as a prosthetic device. They must be medically necessary to treat a person’s heart condition.
There are four parts to Medicare that may help with the costs of a pacemaker. The following sections look at these in more detail.
Part A
Part A covers a person for inpatient hospital care. The procedure to fit a pacemaker often takes place in the hospital, meaning that Part A would cover eligible costs.
Medicare Advantage plans would also cover eligible expenses, as they must provide the same Part A benefits.
Under Part A, an individual must pay some out-of-pocket expenses, such as the benefit period deductible. In 2024, this is $1,632 for the first 60 days.
The day someone gains admittance to the hospital is when the benefit period begins. There are additional costs for hospital stays longer than 60 days.
Part B
Medicare Part B covers outpatient medical care and can help cover the cost of doctor visits, such as any necessary adjustments to the pacemaker on an outpatient basis.
A person will usually pay a coinsurance of 20% of eligible outpatient costs in addition to a monthly premium. The standard 2024 premium is $174.70.
The amount a person pays for their Part B premium will depend on their reported income to the Internal Revenue Service 2 years earlier. This means that an individual’s 2024 premium will vary depending on their reported income from 2022.
Part C (Medicare Advantage)
Medicare Advantage plans combine the benefits of Medicare parts A and B, so pacemaker coverage follows the same benefit rules.
Private insurance companies administer Medicare Advantage plans, and these often provide additional coverage, such as dental or optical care.
Medicare Advantage premiums vary depending on the insurance company, a person’s plan, and their location. Out-of-pocket expenses may also vary, and plans may charge more if someone uses a provider outside of their network.
Part D
Private insurance companies also administer Medicare Part D plans, which are prescription drug plans.
Part D plans may help cover the cost of the prescription medications relating to pacemakers.
As with Medicare Advantage plans, out-of-pocket costs can vary according to the plan provider, where the person lives, and their plan type.
Several programs can help pay medical expenses. These include:
- Medicaid: Medicaid is a joint federal and state program that helps with medical costs. A person can check their eligibility on the Medicaid website.
- Medicare savings programs: Medicare savings programs can help pay out-of-pocket expenses, such as deductibles, coinsurance, and copayments.
- Extra Help: Extra Help helps a person cover the costs of their prescription drugs.
- Supplemental Security Income (SSI): SSI is a monthly benefit that the Social Security Administration may pay. It is not the same as retirement benefits.
Pacemakers are small electrical devices that help control atypical heart rhythms. They connect to the heart and send electrical impulses that enable it to beat regularly.
Pacemakers use a battery and a small computer to monitor and control the heartbeat. New pacemakers can also monitor blood pressure and breathing.
The device records all electrical activity from the heart and allows doctors to access these recordings. A doctor can then adjust the settings to a person’s medical needs.
A person may need a pacemaker
- damage after a heart attack
- electrical problems that affect heart rate
- heart failure
- an enlarged heart
Learn about recovery from pacemaker surgery.
Medicare will pay for a pacemaker when it is medically necessary.
Part A helps cover the costs of inpatient care necessary for pacemaker surgery, while Part B helps cover the costs of doctor visits to monitor and adjust the pacemaker. Advantage may also help cover these costs.
Medicare Part D helps cover the prescription medication a person may require after the procedure.
Programs such as Medicaid may also help with medical expenses.