Does Medicare Cover Pacemakers?
- January 12, 2024
- Reviewed by John Krahnert
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.
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How much does a pacemaker cost with Medicare?
On average, a pacemaker will cost $2,800 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.
2024 Part A Costs
Some of the Part A out-of-pocket costs you may face include:
- Part A deductible: $1,632 per benefit period in 2024
- Part A coinsurance:
- Days 1-60 spent in the hospital: $0 coinsurance for each benefit period
- Days 61-90: $408 coinsurance per day of each benefit period in 2023
- Days 91 and beyond: $816 coinsurance per each “lifetime reserve day” after day 90 for each benefit period in 2023
- 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.
2024 Part B Costs
Some of the Part B out-of-pocket costs you may face when getting a pacemaker include:
- Part B deductible: $240 per year in 2024
- 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 and may offer benefits not covered by Original Medicare.
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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About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
