Does Medicare Cover 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 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, 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, 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, provided by private insurers, will only cover any prescription medication after a pacemaker surgery.

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.

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.

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.

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.