Does Medicare Cover Your Pacemaker? What You'll Pay

By: Meredith Miller
Published: Tuesday, October 30 2018
Last Updated: 4 years ago

Health issues are concerning for everyone, especially when it comes to your heart, arguably the most important organ in your body. If you’ve recently been diagnosed with heart complications and will require a pacemaker as the result, you probably have a host of questions and concerns, and rightfully so.

First and foremost, you want to know exactly what a pacemaker is, how it will correct your issues, and how it will affect your everyday life. After the dust settles a little, Medicare beneficiaries probably have a second concern, which is how they will be able to afford the vital piece of equipment. If you are living on a fixed income, and have a limited budget, here’s what you need to know in regards to whether or not Medicare will cover your pacemaker, and what you’ll end up paying out-of-pocket.

What Is A Pacemaker?

Put simply, the pacemaker is fitted into a patient's chest in order to help correct and regulate the rhythm of the heart. The pacemaker can detect irregularities in the heartbeat whenever the rhythm slows down or speeds up, and then helps the patients heart by using electrical pulses to help the heart stay on pace. Generally speaking, there is a period of eight weeks after having a pacemaker fitted in which the patient has to allow for the device to settle itself firmly into its spot.

Who Needs Pacemakers

When a doctor has performed a battery of tests and determined that a patient's heart is displaying arrhythmic beating, which may include beating either too fast or too slow, the recommendation will often be that the patient should have a pacemaker fitted. Arrhythmia can cause patients to suffer symptoms that include being tired and short of breath among other issues.

These symptoms often result from arrhythmic beating creating a situation in which the patient's heart is unable to pump sufficient blood through the patient's blood vessels. A pacemaker serves the critical role of helping to alleviate the arrhythmic beating. This has the benefit of correcting the other issues.

Will Medicare Cover The Cost Of Your Pacemaker?

What patients immediately want to know in regard to pacemaker cost is the question of whether or not the device will be covered within the terms of their Medicare plan. The answer is simply that the pacemaker cost will be shared and the coverage plan will cover a significant portion of the overall pacemaker cost. In terms of having a pacemaker fitted, the patient must pay 20% of the total approved costs for the device as well as paying a copayment toward the surgical procedure that is necessary to implant the pacemaker device.

Part A or Part B deductibles will apply, and these must be paid the majority of the time before the coverage plan kicks in the cover the rest.

Would Medicare Supplement Plans Help With The Cost?

Since as much as 80% of the pacemaker process might be pain out of the standard plan, patients also want to know what the situation is in terms of a Medicare Supplement Plan that will cover out-of-pocket financial requirements. The majority of the supplement plans that are available out there will cover some portion of the remaining 20% that Original Medicare does not account for in terms of having a pacemaker fitted. Medicare Supplemental (Medigap) Plans can be obtained through companies that offer private insurance plans.

Additional Details

As stated previously, there is an adjustment period after having a pacemaker fitted. Beyond this, there are a few other factors that pacemaker patients need to keep in mind in terms of living with their pacemaker.

Generally speaking, being a physically active person is an important factor in living with your pacemaker but patients must also be cautious to not over-do things. It is also important that a patient makes sure to go in for all routine checkups on their pacemaker device. Carrying a pacemaker identification card is a critical practice which helps workers in the healthcare field to assist you. It is also critical that a patient seeks medical attention immediately if they experience situations such as shortness of breath, dizziness or swelling.

Your doctor or physician will likely go over all the important information you need to know about living a healthy and active life with a pacemaker. Make sure to ask about any questions you have, and follow up appointments.