Medicare coverage for Pacemakers is available when medically necessary. Pacemakers are incredibly reliable devices that aid in the treatment of heart arrhythmia.
Arrhythmia or Atrial fibrillation is an irregular heartbeat in which the heart can beat either too slow or too fast. This condition can become dangerous because the body’s organs don’t receive a constant supply of blood and can become severely damaged.
A pacemaker is programmed, especially for the patient’s medical condition and needs. The device is a battery, electrodes, and a generator.
The electrodes attach to the patient’s heart and works of sensing your heart rate. The electrical pulse the device puts off helps to correct the irregular heartbeats.
Your doctor may recommend a pacemaker if you have any of the following:
- You cannot perform everyday activities
- You suffer from health issues that increase the chances of heartbeat complications
- The use of a pacemaker can correct heart rhythm
To have a pacemaker inserted, a patient must undergo a surgical procedure. The surgery typically lasts a few hours and can be done as an outpatient procedure.
Risks associated with this procedure are usually low, and patients tend to resume regular activity within a week.
How Much Does a Pacemaker Cost
The average price to insert a pacemaker without insurance can be over $20,000 in most cases. For some, it could be above $90,000.
Although, having complications during surgery raises the cost of implantation.
Those with Medicare could pay over $2,000, while those with private insurance will pay more. Of course, the hospital costs and the coverage you have will all be determining factors in price.
Let’s say Jeff has only Medicare and gets a pacemaker; it costs him $3,000. However, Julie has Supplement Plan N, and her pacemaker doesn’t cost her anything more than her premium.
Now, there are other instances where a beneficiary has Medicare Advantage. Advantage plans vary by county, so you’ll need to consult an agent to determine a price estimate on a pacemaker.
Does Medicare Cover Pacemakers
You get 80% Medicare Coverage on Pacemakers when a doctor says it’s medically necessary. The patient must have cardiac irregularities or atrial fibrillation that requires the use of the pacemaker.
Not only will the actual device have coverage, but the surgery for insertion has coverage.
When complications arise during surgery, the costs overall increase. Having a Medigap policy can be the difference between $0 copayment and 20% of $90,000.
Anyone at risk for heart problems needs to have a Supplement to protect against financial burdens in the form of medical bills.
Medicare Guidelines for Pacemaker Checks
Patients should undergo pacemaker checks six weeks post-operation. From that point, these checks should be completed every three to six months to ensure the battery function is acceptable.
During these pacemaker checks, physicians will check to see if the device has treated any abnormal heart rhythms and will confirm the battery life is still good.
Medicare Coverage for Medtronic Pacemaker
Medtronic Surescan technology creates pacemakers, and your physician may decide to recommend that you.
The deciding factors of suitability are your specific heart conditions and other health issues.
One lead of the device is put into the right atrium while the other goes into the right ventricle of the heart.
Medicare Coverage for Biventricular Pacemaker
Biventricular pacemakers work both lower chambers of the heart. Medicare covers biventricular pacemakers but requires regular monitoring of the devices.
Biventricular devices are monitored every two weeks within the first month, and every four weeks from that point up until the 7th month.
From seven months until three years post-surgery, pacemakers will go through monitoring every eight weeks.
Pacemaker Battery Replacement
Usually, pacemaker batteries have a 7 to 8-year lifespan. When a pacemaker battery starts wearing down, the patient will need a new pacemaker implanted.
Of course, this means undergoing another surgical procedure. Typically, the original pacemaker leads won’t need to replacement during this additional surgery.
Medicare covers battery replacements in single and dual chamber pacemakers. For other conditions, Medicare will approve when necessary.
The Cost of Defibrillator Battery Replacement Surgery
The estimated cost of a battery replacement surgical procedure is around $37.000. Usually, batteries are good from anywhere from five to seven years before needing replacement.
Medicare Coverage for Transtelephonic Pacemaker Monitoring
Transtelephonic pacemaker devices are small electronic mechanisms that work hand in hand with the pacemaker. Their job is to transfer the patient’s heart rhythm live over the phone.
Technology, like the transtelephonic pacemaker, allows patients to send heart rhythm recordings to doctors by the internet or fax.
Medicare covers transtelephonic monitoring devices when the record is at least thirty seconds long and viewable on an ECG strip.
Medicare Coverage for Pacemakers FAQ’s
Medicare Advantage Coverage for Pacemakers
Advantage Plans will, at the very minimum, cover pacemakers to the same extent as Medicare coverage. Beneficiaries may be responsible for paying 20% of the cost of outpatient services.
Advantage plans have low premiums, which is why they cost more when you need coverage. You either pay a premium and little out of pocket; or, you pay a little premium and a lot out of pocket.
Some people don’t worry about paying high deductibles or coinsurances. Others, know it’s good to have the safety net when you fall.
Medicare Supplement Coverage for Pacemakers
Supplement Plans work in conjunction with Part A and B. They help cover costs that would otherwise be the patient’s responsibility with Medicare.
Monthly Medigap premiums vary depending on the policy, your location, and the insurance company. Supplement plans cover the deductibles, coinsurances, and copayments you’d otherwise pay.
To purchase the best supplement for your needs, call one of our agents at the number above. We’re here to assist you with every concern and question you may have.
Can’t call now? Fill out an online rate form and an agent will contact you to discuss your needs and the best plans in your area.