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Medicare Coverage for Pacemakers

Medicare coverage for pacemakers is available when medically necessary. Pacemakers are incredibly reliable devices that aid in the treatment of heart arrhythmia.

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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.

Does Medicare Cover Pacemakers?

Yes, there’s Medicare coverage for 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.

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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.

Medicare Coverage for Transtelephonic Pacemaker Monitoring

Medicare covers transtelephonic monitoring devices when the record is at least thirty seconds long and viewable on an ECG strip. 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.

Does Medicare Cover Pacemaker Battery Replacements?

Medicare covers battery replacements in single and dual chamber pacemakers. For other conditions, Medicare will approve when necessary.

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.

Do Medicare Advantage Plans Cover Pacemakers?

Advantage Plans will, at the very minimum, cover pacemakers to the same extent as Medicare coverage.  Advantage plans have low premiums, which is why you’ll spend more out of pocket for medical services. You either pay a premium and little out of pocket; or, you pay a little premium and a lot out of pocket.

Do Medicare Supplements Cover Pacemakers?

Medicare Supplements work in conjunction with our Original Medicare benefits. They help cover costs that would otherwise be the patient’s responsibility with Medicare.

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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.

How to Get Help Covering Pacemankers with Medicare

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.

Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Medicare Insurance Agent, she brings a wealth of knowledge and expertise to her writing.

20 thoughts on "Medicare Coverage for Pacemakers"

  1. My uncle is waiting for his second pacemaker. He is waiting for Medicare to approve for coverage and surgery. He has been put on hold for days and possibly weeks. He was told that if he didn’t get this soon he could die in 30 days. What is the hold up?

    1. Brooke, I am very sorry to hear your uncle is having this issue. Unfortunately, depending on the plan he has, prior authorization can take some time as each insurance company has a different process when it comes to authorizing claims. I recommend calling his insurance company and asking if additional information is required to speed up the process.

  2. Jagger, my father’s doctor told him his heart is working at only 30% and he needs a pacemaker and defibrillator implant. He already has 3 stints implanted a d he is 65 years old. He has already had open heart surgery due to a heart attack a few years back. He was told it would happen in 1 week, but Medicare denied the operation. What can or should we do about that?

    1. Gloria, I am sorry to hear about the trouble your father is having with this. I recommend contacting his carrier to find out why the surgery is being denied. If the doctor is still unable to get the procedure approved, your father can file an appeal with his insurance company to review the denial.

  3. My pacemaker is getting close to needing battery replacement. If estimated to need replacement in April 2022. How many months ahead of that estimated date will Medicare pay for a replacement?

    1. Hi Donald! If your doctor finds during your pacemaker check that it is time to replace the battery, Medicare will cover it. There is no timeline outside of when your doctor says its medically necessary.

  4. I am a 72 yr old expat living in Thailand. I was recently diagnosed with a-fib and my Thai doctor said I would be needing a pacemaker within the next year. I have Medicare A&B. & understand my out of pocket costs would be 20%. Is there a yearly cap for charges that I would be responsible?

    1. Hi Dee! Unfortunately, there is no out-of-pocket limit with Part A & Part B. You would need a Medicare Advantage or Medigap plan to cover the cost-sharing.

  5. My sisters Medtronic’s pacemaker has been working at only 50% tested by electronic tech for over two years. She has been in constant a fib for at least a year. Her cardiologist says medicare (she has A B and a great supplemental)will not pay until the warranty replacement date in December do he can not help her??? How can this be true? She has been in and out of the hospital at least ten times for fluid buildup congestive heart failure and on going a fib.

    1. Hi Deborah! I would call Medicare directly with her doctor to get this taken care of ASAP. Medicare WILL replace pacemakers early due to poor performance, premature failures, or medically necessary upgrades.

  6. It’s time for my replacement for the 2nd time but they are wanting $5k which at $800/ month isn’t feasible. I have part A and part B what should this cost

    1. Hi Toby! If you have Part B, that will cover 80% of the cost of your pacemaker. That leaves you responsible for 20%, plus the Part B deductible of $203 if that has not been met for the calendar year yet. If you’re lower-income, you may qualify for a Medicare Savings Program which will help cover your out-of-pocket costs.

  7. Does Medicare cover a replacement pacemaker, in other words, the 1st pacemaker has been in place for more than 10 years and a new one is medically prescribed. Will Medicare cover the 2nd one?

  8. I have developed a 2nd degree AV heart block, Mobitz II. This is causing significant skipped beats of my heart, mostly when sitting and lying down. The doctor has a patch Holter monitor on me for 14 days. Will Medicare pay for a pacemaker? I have Medicare A+B and a plan G.

  9. im a 72 year old that needs a pacemaker due to heart fibrillation,i have no private cover
    what cost would i be paying being a pensioner ?

    1. Hi Alan! If you have Part B, you’ll be responsible for 20% of the cost of the pacemaker if you don’t have a Medigap plan.

    1. As long as your doctor finds the battery replacement medically necessary, Medicare will cover it.

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