The United States is the leading country in a study by the World Society of Arrhythmias on how many people worldwide have pacemakers. The study occurred in 61 countries. Out of the 1,002,664 individuals worldwide, the US led with just over 225,000 citizens that rely on a pacemaker.
Below, we’ll discuss Medicare coverage for pacemakers, the conditions they treat, and how to get additional Medicare coverage.
Medicare Coverage for Pacemakers
Implanted pacemakers assist with controlling heart rhythm. In some cases, they are temporary, but in the majority, the implantation of a pacemaker is permanent. Medicare will cover the costs if your physician determines that a pacemaker is medically necessary.
How does Medicare cover pacemakers?
The Medicare program will cover pacemakers. Your surgery for the pacemaker implantation is usually performed as an inpatient hospital procedure and requires a hospital stay. Medicare Part A will cover the procedure.
You’ll be responsible for your Medicare Part A deductible. If you are out of the hospital and back home within 90 days, Medicare Part A covers the surgical procedure.
Medicare Part B would cover pacemaker services that fall under outpatient care. Since the pacemaker is considered Durable Medical Equipment, you’re responsible for your Medicare Part B deductible and a 20% coinsurance of the Medicare-approved amount.
Medicare Part D will cover prescription drugs needed after the procedure.
Medicare Supplement Coverage for Pacemakers
The most comprehensive coverage you can add to Original Medicare is a Medicare Supplement plan. These Medigap insurance plans work as secondary coverage to traditional Medicare.
Your Medicare Supplement health plan will also pick up anything that Medicare pays under Medicare Part A or Part B.
The Centers for Medicare & Medicaid Services have standardized and regulated these plans. Depending on your plan letter, you may have little to nothing to pay out of pocket for a pacemaker.
These plans do have additional premiums in addition to your Medicare premium. Since Medicare Supplement plans only cover items included under Medicare Part A and Part B, you’ll need to enroll in Part D prescription drug plan for prescription drug coverage.
Medicare Advantage Coverage for Pacemakers
Another additional Medicare option to consider is a Medicare Advantage plan. Commonly referred to as Medicare Part C, these plans are required to offer, at a minimum, the same coverage provided by Medicare Parts A and B.
Private insurance companies administer these plans and provide additional benefits not covered by Original Medicare.
Medicare Advantage programs have their copays and costs associated with them. An implanted cardiac pacemaker could be a fixed, predictable copay. These plans can vary greatly depending on where you live and your chosen plan.
When is a Pacemaker needed?
Your doctor may recommend a pacemaker if you live with health conditions that cause heart complications. Some common reasons one may need are if you have a health condition that may cause
heart rhythm disorder or trouble performing daily activities. The following medical conditions may require a pacemaker.
- Irregular heartbeat
- Single-chamber pacemaker
- Atrial fibrillation
- Heart Failure
In addition to the conditions listed above, other heart conditions may become life-threatening and require the implantation of a pacemaker.
Types of Medicare-Covered Pacemakers
Several types of pacemakers are available to treat different heart diseases and complications. Depending on the reason you need a pacemaker, your doctor will prescribe one of the following:
Single Chamber Pacemakers
Single chamber pacemakers have a single lead attached to the heart’s top or bottom.
Dual Chamber Pacemakers
Dual chamber pacemakers have two leads. One is attached to the top of the heart, and the second is to the bottom.
Biventricular pacemakers are special pacemakers that are also called cardiac resynchronization therapy. They have three leads attached to the heart to help adjust the rhythm of the heart. One lead connects to the top, and the other connects to the bottom.
- Damage after a heart attack
- Enlarged Heart
- Electrical problems affecting heart rate
- Heart failure
How the Pacemaker Type Determined
Your doctor will schedule and have several tests completed to determine if a pacemaker is required and which type of device is needed. These tests determine the root cause of your irregular heartbeat.
Electrocardiogram (EKG or ECG)
An EKG is a non-evasive test that measures the electrical activity of your heart. Electrodes are attached to the chest; in some cases, electrodes get attached to the chest, legs, and arms. The electrodes communicate with a computer that displays the results. An EKG can show whether the heart is beating too slowly or not.
An Echocardiogram uses sound waves to create an image of the heart. Your healthcare provider will use it to determine your heart’s size, motion, and structure.
A Holter monitor is a small wearable device that monitors and tracks your heart’s rhythm. Your doctor may require you to wear the monitor for multiple days. Holter monitoring is a valuable test to detect issues that are hard to replicate and occur randomly and unpredictably.
Stress tests monitor or determine heart issues that only occur while exercising. When taking a stress test, you’ll generally have an EKG as a baseline, followed immediately by a light workout on a treadmill or bike. You’ll receive another EKG test once you have completed the light exercise. Sometimes, a stress test will include an echocardiogram or nuclear imaging test.
Does Medicare cover pacemakers?
Yes! Medicare will cover a pacemaker if your healthcare provider says it’s medically necessary.
How much does a pacemaker cost with Medicare?
Your final cost of the implantation of a pacemaker depends on your healthcare coverage and plan. If you remain on Original Medicare only, you could be susceptible to 20% or between $10,000 and $100,000 by completing all tests and procedures. However, beneficiaries with a Medicare Supplement plan could have little to no costs.
Does Medicare cover pacemaker battery replacement?
Original Medicare provides coverage for replacing batteries in single and dual-chamber pacemakers when deemed medically necessary. As per information from Hopkins Medicine, most device batteries typically have a lifespan of approximately 5 to 7 years.
Does Medicare insurance pay for pacemakers?
Your Medicare insurance will pay all or a portion of the costs related to your pacemaker if it’s medically necessary. How much you pay varies greatly depending on the insurance you carry.
Is the cost of a pacemaker covered by Medicare?
Medicare will cover the costs of a pacemaker as long as your physician deems it medically necessary.
How to Get Medicare Coverage For a Pacemaker
Medicare is great coverage but can be a bit complicated. Let our licensed experts assist you in making the process smooth. We can educate and answer any questions and help with the enrollment process. Give us a call or fill out our online request form for assistance.
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