Does Medicare Cover a Pacemaker and Related Costs?

Medicare helps beneficiaries manage the costs associated with pacemakers, including the device, implantation, and necessary follow-up care. Understanding coverage involves its different parts and your financial responsibilities.

Medicare Part A Coverage for Pacemaker Implantation

Medicare Part A, Hospital Insurance, covers inpatient hospital stays when a pacemaker implantation procedure is medically necessary. It covers your hospital room, meals, nursing services, and supplies during your inpatient stay. Part A specifically addresses facility costs for the surgical procedure when performed in an inpatient setting.

For an inpatient hospital stay, Medicare Part A covers expenses from the day of formal admission. This includes the operating room and recovery room. It addresses hospital charges related to your admission for pacemaker surgery, provided the stay is medically necessary.

Medicare Part B Coverage for Pacemaker Services

Medicare Part B, Medical Insurance, covers services related to pacemakers outside inpatient hospital facility costs. It covers the pacemaker device and professional services by doctors, including the surgeon and anesthesiologist.

Part B covers outpatient diagnostic tests, such as EKGs and imaging, before implantation. If the procedure is performed in an outpatient setting, like a hospital outpatient department or an ambulatory surgical center, Part B covers these facility costs.

Your Financial Responsibility with Original Medicare

With Original Medicare (Parts A and B), beneficiaries are responsible for out-of-pocket costs for pacemaker services. For inpatient hospital stays covered by Part A, you pay a deductible per benefit period. In 2025, this Part A deductible is $1,676 for each benefit period. A benefit period begins on the day you are admitted as an inpatient and ends after you have been out of the hospital or skilled nursing facility for 60 consecutive days.

After meeting the Part A deductible, there is no additional coinsurance for the first 60 days of an inpatient hospital stay. For services covered under Part B, such as the pacemaker device and doctor’s services, you must first meet an annual deductible. In 2025, the Part B annual deductible is $257. Once this deductible is satisfied, you pay 20% of the Medicare-approved amount for most Part B-covered services, with Medicare paying the remaining 80%.

Medicare Advantage Plans and Supplemental Coverage

Medicare Advantage Plans (Part C) are offered by private insurance companies approved by Medicare. These plans must provide at least the same coverage as Original Medicare (Parts A and B), including pacemaker services. While they cover the same services, Medicare Advantage plans often have different cost-sharing structures, such as deductibles, copayments, and coinsurance, compared to Original Medicare.

These plans may have network restrictions, requiring you to use in-network doctors and hospitals for the highest coverage. Medicare Advantage plans may require prior authorization for certain services, including pacemaker procedures. Unlike Original Medicare, they include an annual out-of-pocket spending limit, capping the amount you pay for covered services in a year.

Medicare Supplement Insurance (Medigap policies) supplement Original Medicare. If you have Original Medicare, a Medigap policy can help cover out-of-pocket costs like deductibles, coinsurance, and copayments. These policies are standardized, with benefits for each plan letter being the same regardless of the insurance company. By paying an additional premium for a Medigap policy, you can reduce your financial responsibility for services like pacemaker implantation and related care.

Post-Implantation Care and Device Management

After a pacemaker is implanted, ongoing care and device management are important for monitoring its function and patient well-being. Medicare Part B covers these follow-up services as outpatient care. This includes regular check-ups to monitor the pacemaker’s performance and heart rhythm.

Part B also covers device checks, which can occur in-person or through remote monitoring systems, allowing your doctor to receive data from your pacemaker. Should a pacemaker battery require replacement, or if the device needs adjustments or reprogramming, these procedures are also covered under Medicare Part B.