Medicare and Pacemakers: What are Coverage Options?

Pacemakers can be vital for those with heart problems, but the cost can be intimidating. If you have Medicare, you may have the coverage needed.

What is a pacemaker?

A pacemaker is a small device that is placed in your chest that helps maintain the proper rhythm or pace of your heart. Pacemakers can also monitor your heart rhythm and whether it is too fast or too slow. It will send electrical pulses to your heart in order to help correct any irregular pace or rhythm.

Medicare coverage

Medicare classifies pacemakers as prosthetic equipment. If a pacemaker is deemed medically necessary by your doctor, you may qualify for coverage. As long as your doctor accepts Medicare, you will likely be required to pay the standard 20 percent Medicare-approved costs for the pacemaker and the copay amount for the surgery. The coverage is under Medicare Part A and B, so you if have not met your deductible, you will have to pay the deductible amount.

Costs after coverage

While Medicare may cover up to 80 percent of costs for a pacemaker, there are options to help cover out-of-pocket costs. Medicare supplement plans are available through private insurance companies for those who are eligible.

There are 10 Medicare Supplement (Medigap) standardized plans that are available in most states. They may cover a portion of the 20 percent Part B copay.

If you think that you are having heart problems, call your doctor immediately. Talk to your doctor about whether a pacemaker is the right option for you and if you have the proper coverage.

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