Medicare typically does cover pacemakers (and the surgery to insert them), as long as the pacemaker is considered medically necessary by a doctor.
Medicare Advantage (Medicare Part C) plans may also cover pacemakers if they are deemed medically necessary, and they also include an annual out-of-pocket spending limit. This can potentially save you money in Medicare costs for your pacemaker implant.
Original Medicare does not include an out-of-pocket spending cap.
How much does a pacemaker cost with Medicare?
Some of the costs of getting a pacemaker (or implantable automatic defibrillator) may be covered by Part A or Part B.
Medicare Part A covers inpatient hospital care. Medicare Part B covers doctor’s services, including preventive care and lab work.
If your pacemaker implant surgery takes place in a hospital, the costs for your hospital stay may be covered by Medicare Part A.
The pacemaker itself and any doctor’s services related to your surgery may be covered by Medicare Part B. Part B will also cover some of the costs if your surgery takes place in an outpatient setting.
2019 Part A Costs
Some of the Part A out-of-pocket costs you may face include:
- Part A deductible: $1,364 per benefit period in 2019
- Part A coinsurance:
- Days 1-60 spent in the hospital: $0 coinsurance for each benefit period
- Days 61-90: $341 coinsurance per day of each benefit period in 2019
- Days 91 and beyond: $682 coinsurance per each “lifetime reserve day” after day 90 for each benefit period in 2019
- Beyond lifetime reserve days: you pay all costs
Your Part A deductible must be paid before Medicare Part A will begin paying its share of covered services.
2019 Part B Costs
Some of the Part B out-of-pocket costs you may face when getting a pacemaker include:
- Part B deductible: $185 per year in 2019
- Part B coinsurance: After you meet your Part B deductible, you typically pay 20 percent of the Medicare-approved amount for most doctor’s services for the rest of the calendar year
Medicare Advantage plans can also cover pacemaker costs
Medicare Advantage plans are sold by private insurance companies as an alternative to Medicare Part A and Part B (Original Medicare).
All Medicare Part C plans must provide at least the same benefits as Part A and Part B. Most Medicare Advantage plans also include prescription drug coverage (a benefit not offered by Original Medicare).
Additionally, many Medicare Advantage plans provide additional benefits, such as:
- Dental coverage
- Vision coverage
- Hearing coverage
- Health and wellness program benefits, such as free gym memberships
If your pacemaker implant costs would be covered by Original Medicare, they will also be covered by a Medicare Advantage plan.
It’s important to remember that Medicare Advantage plans include an annual out-of-pocket spending limit, which Original Medicare does not offer.
A licensed insurance agent can help you find Medicare Advantage plans in your area that may cover pacemakers.
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