Medicare covers pacemakers under Part B, but you pay a share of the cost

Medicare Part B covers the pacemaker device itself, the surgery to implant it, and the doctor's fees. You pay 20 percent of the approved amount after you meet your Part B deductible for the year. The remaining 80 percent goes to Medicare. The actual cost to you depends on what your doctor's office charges and whether they accept Medicare's approved amount as full payment.

The device itself can cost between $20,000 and $50,000 before insurance, though Medicare negotiates a lower approved amount. Your 20 percent share of that approved amount is what you owe — not 20 percent of the full retail price. If your doctor is a Medicare participating provider, they cannot bill you for the difference.

Hospital charges for the implant procedure are covered under Part A if you stay overnight. If the procedure happens in an outpatient surgery center, Part B covers it instead. Either way, you pay your deductible and coinsurance.

Key Takeaways

  • Medicare Part B covers the pacemaker device, implant surgery, and doctor fees after you meet your annual deductible.
  • You pay 20 percent coinsurance on the Medicare-approved amount, not on the full device price.
  • Overnight hospital stays for implant are covered under Part A; outpatient procedures are covered under Part B.
  • Follow-up visits and device checks are covered as office visits, and you pay your regular copay or coinsurance.
  • Supplemental insurance (Medigap) or Medicare Advantage plans can reduce or eliminate your out-of-pocket costs.

What costs you will owe before and after implant

Before the procedure, you owe your Part B deductible if you have not met it yet this year. In 2024, that deductible is $240. Once you meet it, you pay 20 percent coinsurance on all covered services for the rest of the year.

The surgeon's fee, the cardiologist's consultation, and the anesthesiologist's fee are all separate line items. Each one is subject to the 20 percent coinsurance. If the implant happens in a hospital and you stay overnight, you also owe your Part A deductible (which is much higher — $1,556 in 2024) plus coinsurance for each day you stay.

After the pacemaker is in place, routine follow-up visits are covered as office visits. You pay your regular copay (usually $15 to $25 for a participating provider) or coinsurance if you see a non-participating provider. Remote monitoring checks, where the device sends data to your doctor's office without an in-person visit, are also covered.

When Medicare does not cover pacemaker costs

Medicare does not cover a pacemaker if your doctor determines it is not medically necessary. This is rare — pacemakers are prescribed only when the heart's electrical system is genuinely failing — but if a second opinion contradicts the first, Medicare may deny the claim.

Medicare also does not cover replacement devices that are purely elective upgrades. If your current pacemaker works but a newer model with more features becomes available, Medicare covers the replacement only if your doctor documents that the upgrade is medically necessary, not optional.

Costs for travel to get the procedure, lodging, meals, or a companion to accompany you are never covered. Neither are any charges from out-of-network providers who do not accept Medicare assignment.

How to reduce your out-of-pocket costs

A Medigap policy (supplemental insurance) can pay most or all of your coinsurance and deductibles. Plans G, F, and N are the most common and cover 80 to 100 percent of what Medicare does not pay. You buy Medigap from a private insurer, and it works alongside Medicare Part A and B.

A Medicare Advantage plan (Part C) bundles Parts A, B, and D into one plan run by a private insurer. Many Advantage plans have lower out-of-pocket maximums than Original Medicare plus Medigap, but you must use in-network providers. If your cardiologist or surgeon is out of network, you may pay more or have to switch doctors.

If you cannot afford either option, ask your hospital's financial counselor about payment plans or hardship programs. Some hospitals reduce or forgive bills for uninsured or underinsured patients based on income.

What happens if you have not met your deductible yet

If your pacemaker implant is scheduled early in the year and you have not yet paid $240 toward your Part B deductible, you will owe that full amount first. After that, you pay 20 percent coinsurance on all covered charges.

If the implant requires an overnight hospital stay, you also owe your Part A deductible ($1,556 in 2024) before hospital coinsurance kicks in. These deductibles are separate — meeting one does not count toward the other.

Once you have met both deductibles in the same year, you pay only coinsurance (20 percent for Part B services, a fixed daily amount for Part A hospital stays). If the procedure happens late in the year, you may meet both deductibles and then have the coinsurance reset when the new year begins.

Device monitoring and replacement coverage

Routine device checks — whether in-person or remote — are covered as office visits. Remote monitoring, where your pacemaker sends data wirelessly to your doctor's office, is covered at no extra charge beyond your regular copay or coinsurance for the office visit itself.

Battery replacement is covered when the battery runs low, usually after 5 to 15 years depending on how often the pacemaker paces your heart. The replacement surgery is covered the same way as the original implant: Part B covers the device and surgery, and you pay your deductible and coinsurance.

If your pacemaker malfunctions and needs to be replaced before the battery is depleted, Medicare covers the replacement as a medically necessary procedure. You pay the same deductible and coinsurance as you would for any other covered surgery.

Frequently Asked Questions

Do I need to get prior approval from Medicare before my pacemaker implant?

Your doctor's office usually handles this. Medicare does not require advance approval for pacemakers in most cases, but your doctor may request a coverage information to confirm the procedure is covered before surgery. Ask your cardiologist's office whether they have submitted a pre-procedure review.

What if my pacemaker is implanted at an out-of-network hospital?

Medicare still covers it, but you may pay more. Out-of-network providers can bill you for the difference between what they charge and what Medicare approves. Ask the hospital whether they accept Medicare assignment before scheduling. If they do not, get a cost estimate in writing.

Does Medicare cover the pacemaker if I have a Medicare Advantage plan instead of Original Medicare?

Yes, but the coverage rules and your costs may differ. Medicare Advantage plans must cover pacemakers, but they set their own deductibles, copays, and coinsurance. Check your plan's summary of benefits or call the plan before scheduling to learn what you will owe.

Will I owe anything if I have both Medicare and Medicaid?

Medicaid may cover costs that Medicare does not, including your deductibles and coinsurance. The rules vary by state. Contact your state Medicaid office or your case worker to learn whether the pacemaker procedure is covered and what your share will be.

What if my doctor says I need a pacemaker but Medicare denies the claim?

You have the right to appeal. Your doctor can submit additional medical records explaining why the pacemaker is necessary. If Medicare still denies it, you can request a hearing before an administrative law judge. Ask your doctor's office to help you file the appeal.