Thankfully, there is Medicare coverage for pacemakers. Medicare covers pacemakers and the surgery to insert them, as long as the pacemaker is medically necessary. Depending on the kind of Medicare coverage you have, you may be responsible for a portion of the cost.
A pacemaker is a small electronic device that treats heart arrhythmias. If you have an arrhythmia, your heart does not beat normally. Although, it may beat too fast (tachycardia), too slowly (bradycardia) or with an irregular rhythm.
Arrhythmia can prevent the heart from pumping enough blood through your body, causing you to feel tired, faint, and short of breath.
Arrhythmias happen when your heart’s natural electrical signaling system doesn’t work properly. However, a pacemaker corrects the problem by sending out low-level electrical pulses.
Some pacemakers are temporary and designed to treat temporary conditions, such as an abnormal heartbeat caused by medication.
If you have an ongoing problem with your heart rhythm, your doctor may recommend a permanent pacemaker. However, a pacemaker goes into the chest or abdomen in a minor surgical procedure.
What are the Risks of Pacemakers
Surgery always carries risk, but pacemaker insertion is a minor, routine, and safe procedure. For most people, benefits are much greater than any risk – more energy, an ability to be more active, and prevention of organ failure, falls, and other complications of severe arrhythmia.
There are, however, some things to be aware of if you have a pacemaker:
- Prolonged, close-up exposure to certain devices can disrupt your pacemaker’s magnetic field. This includes airport metal detectors, electrical generators, and cell phones. Ask your doctor for guidance on safe exposure to electrical devices.
- You may need to avoid certain rough physical activity that could dislodge the wires in your pacemaker.
- You should schedule regular checkups with your doctor to ensure your pacemaker is working properly.
- Eventually, you will need additional, less extensive surgery to replace your pacemaker battery and generator. Average pacemaker battery life is 6-7 years.
Medicare Coverage for Pacemakers
The pacemaker itself is considered a prosthetic device, and it may be inserted in an outpatient procedure, or while you are an inpatient in the hospital.
If the pacemaker surgery is performed during a hospital stay, it is covered by Medicare’s hospitalization coverage, otherwise known as Medicare Part A. Medicare Part A has a deductible ($1,340 in 2018), and you may be responsible for some copayments or coinsurance.
If your doctor inserts a pacemaker during an outpatient procedure at a hospital or clinic, the pacemaker procedure will fall under Medicare’s medical, or Part B, coverage.
Part B also has a deductible ($183 per year in 2018), and you will be responsible for 20 percent of the Medicare-approved cost of the procedure.
Medigap Coverage for Pacemakers
Medigap, or Medicare Supplement, plans work alongside Medicare Parts A and B. They pick up some of the expenses you would be responsible for if you only had traditional Medicare. However, in most states, you can choose from 10 standardized plans that offer different levels of coverage.
All Medigap plans give you additional coverage for pacemakers.
Here are examples from some of the most popular plans:
- Plan G. If you are hospitalized for pacemaker surgery, Plan G will cover the Part A deductible and additional days in the hospital. For an outpatient procedure, Plan G will pay your 20 percent share of costs, plus any excess charges.
- Plan N. Plan N also pays the Part A deductible and additional days in the hospital. If your pacemaker is inserted as part of an outpatient procedure, Plan N will pay your 20 percent coinsurance, but you may be responsible for a flat copay of up to $50.
Although, Medigap plan premiums can vary depending on your location, the insurance company, and the plan you choose.
What About Medicare Advantage and Pacemakers
If you have Medicare Advantage, you probably know that it is a private insurance substitute for Traditional Medicare.
At a minimum, Medicare Advantage plans must cover pacemakers at the same level as if you had chosen Original Medicare instead.
However, depending on your plan, you may be responsible for deductibles and coinsurance – including 20 percent of the cost of outpatient procedures.
Medicare Advantage plans also have provider networks, and you must use in-network providers to get the most out of your benefits.
Let Us Help Find the Best Coverage for You
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