Different Medicare plans can help cover the cost of your pacemaker device, placement procedure, and follow-up care. You may be responsible for some out-of-pocket costs, depending on the type of coverage you have.

Medicare covers pacemakers as long as they are deemed medically necessary by a Medicare-approved healthcare professional.

Each part of Medicare provides different coverage you may need when you get a pacemaker.

Part A is hospital insurance. The procedure to fit a pacemaker typically occurs in a hospital, so Part A will cover the care you receive during an inpatient stay.

It may also cover limited home healthcare services, nursing facility stays, and inpatient rehabilitation services after your pacemaker procedure.

Here are the basic costs for Part A in 2024:

  • $278 to $505 premium, if you have one
  • $1,632 deductible for each benefit period
  • 20% of all Medicare-approved costs during the stay
  • $0 coinsurance for days 1 to 60 of treatment after you pay your deductible
  • $408 coinsurance per day for days 61 to 90 of treatment
  • $816 coinsurance per day for days 91 to 150 of treatment while using your 60 lifetime reserve days
  • 100% of the treatment costs for days 151+

Part B is medical insurance. It covers outpatient care, including doctor visits to monitor or adjust your pacemaker and medically necessary equipment upgrades or replacements.

Here are the basic costs for Part B in 2024:

  • $174.70+ monthly premium, if you have one
  • $240 deductible
  • 20% of all Medicare-approved costs during your treatment
  • any copayment or coinsurance fees

Part C, or Medicare Advantage, bundles hospital and medical insurance with prescription drug coverage (Part D).

Some Part C plans offer additional benefits, including nonemergency transportation to medical visits and meal delivery to your home after inpatient discharge, that may be useful after your pacemaker procedure.

Costs vary depending on the plan and provider you choose. Each plan has a different premium, deductible, copayment, and coinsurance amount.

Once you pay your plan’s out-of-pocket maximum, your plan will cover 100% of all Medicare-approved costs.

Part D covers prescription medications that you may need at home after having the pacemaker procedure.

The amount of coverage each plan provides depends on its formulary and tier system. A formulary is a list of medications the plan covers. Those medications are then divided into groups or tiers, typically based on cost.

Ask your doctors what medications you’ll need, then talk with your plan provider about your coverage to get an estimate of your copay or coinsurance costs.

Medigap, or Medicare supplement insurance, can help you manage out-of-pocket costs associated with parts A and B. This includes premiums, deductibles, copays, and coinsurance costs.

You can only enroll in Medigap if you have an Original Medicare plan. You can’t enroll in Medigap if you have a Part C plan.

Your out-of-pocket costs can vary depending on the type of coverage and parts of Medicare you’re enrolled in.

You must go to Medicare-approved healthcare professionals and facilities that accept Medicare assignments to receive full benefits and coverage.

It’s important to discuss all potential out-of-pocket costs with your plan provider before you have the procedure.

They can confirm whether the healthcare professional performing the procedure and the facility are a part of your plan’s “network” and provide a cost estimate.