Your heart is the most important muscle in your body; it beats approximately 100,000 times per day. The heart gets blood to where it needs to go in your body, but sometimes it requires help to get the job done.
In some cases, a pacemaker can help your heart do its job more effectively. Medicare plans typically cover pacemakers, but let’s take a look at the specifics of coverage, costs, and more.
If a pacemaker is deemed medically necessary for your care by a Medicare-approved healthcare provider, its cost will generally be covered.
The following sections provide a breakdown of what each part of Medicare covers.
Medicare Part A will cover costs when you’re admitted to the hospital as an inpatient. It may also cover some limited home healthcare services and nursing facility stays, as well as inpatient rehabilitation services after your pacemaker procedure.
Medicare Part B will cover costs that are associated with outpatient services, including:
- medical procedures
- doctor’s office visits
- durable medical equipment
Medicare Part C, also known as Medicare Advantage, is required to cover at least as much as original Medicare (parts A and B).
Part C plans may also offer additional benefits. These benefit may include nonemergency transportation to medical visits, meal delivery to your home after inpatient discharge, and other services you may need after a pacemaker implantation.
Medicare Part D covers prescription medications that you may need at home after having the pacemaker procedure.
Medigap plans, or Medicare supplement insurance, can help you manage out-of-pocket expenses that aren’t covered by Medicare parts A and B.
To be eligible for Medicare coverage, you must be 65 years old or over, or have an eligible disability or health condition that qualifies you for coverage.
Once you’ve enrolled in Medicare, you must go to Medicare-approved healthcare providers and facilities that accept Medicare assignment in order to receive full benefits and coverage.
Importantly, your doctor must state that a pacemaker is medically necessary to treat your condition.
Your out-of-pocket costs can vary depending on the type of coverage and parts of Medicare you’re enrolled in.
Each part has a cost associated with services that you might need if you have a pacemaker implantation. It’s important to discuss all potential out-of-pocket costs with your doctor, Medicare, or a Medicare Advantage provider before you have the procedure.
It is also important to contact the facility where you’ll have the procedure, since there may be a facility fee on top of any coinsurance costs.
Part A coinsurance costs
- Days 1 through 60. After you’ve paid your Part A deductible, Medicare pays the full cost for 60 days of inpatient care. The only time you might have an extra cost is if your doctor orders a service or treatment that’s not covered by Medicare.
- Days 61 through 90. In 2020, you would pay $352 per day as coinsurance.
- Days 90 through 110. You can use 20 of your lifetime reserve days, paying $704 per day in 2020. If you don’t want to use up your lifetime reserve days, you can choose to pay the full cost of the 20 extra days in the hospital.
After the deductible is met, you’ll pay a 20 percent coinsurance for services, therapies, and tests that fall under your Part B coverage.
With Medicare Part C, costs vary from plan to plan. Each plan has different copays, coinsurance, and deductibles. Contact your plan provider before your procedure to understand what expenses you’ll be expected to cover.
Costs for Part D also vary depending on which plan you have.
Each plan has a formulary, or list of covered drugs. Each formulary covers different amounts for the prescription drugs you may need following pacemaker implantation.
Ask your doctors what medications you’ll need, then talk to your plan provider about your coverage to estimate your copay amounts.
Pacemakers are small, implantable medical devices that create electrical impulses to help your heart beat regularly and effectively. Pacemakers can also be combined with defibrillators, which help shock your heart out of an arrhythmia (irregular rhythm) that may be life threatening.
Pacemakers are used to treat many different heart conditions.
If your heart beats too fast or too slow, your blood is not properly circulating throughout your body. Since blood carries oxygen to different organs, this can mean your body isn’t getting the oxygen it needs.
Symptoms to watch for include:
- dizziness or lightheadedness
- chest pain
- shortness of breath
These symptoms can be a sign of many serious heart-related conditions. If you’re experiencing any of them, call your doctor immediately or go to the nearest emergency room.
Heart diseases and conditions
Heart diseases or conditions that may require a pacemaker include:
If you’re diagnosed with any of these conditions, you may see an electrophysiologist. This is a type of doctor who specializes in the electrical functioning of the heart.
What to expect after getting a pacemaker
If you’ve had a pacemaker implanted, there are a few things to keep in mind after surgery:
- You won’t be able to lift anything heavy or exercise normally until your doctor says it’s safe to do so.
- You’ll need to connect your pacemaker to your doctor’s office for remote monitoring at regular intervals. This keeps the pacemaker working smoothly and effectively.
- You may need to keep your cell phone or other devices out of your shirt pocket if it’s near your pacemaker. Sometimes, electronic devices can interfere with a pacemaker’s functioning.
- Certain medications may help your heart function better with a pacemaker, so you may have to change your medication regimen. Your doctor will prescribe any new medications, discuss how to take them, and let you know of any potential side effects.
- Medicare covers pacemakers as long as they are deemed medically necessary by a Medicare-approved healthcare provider.
- Each part of Medicare provides different coverage you may need when you get a pacemaker.
- Contact Medicare and your Part C or Part D plan provider to make sure you know all the out-of-pocket costs you’ll be responsible for.