Medicare covers the Watchman procedure, but only under specific conditions and only after you have tried blood thinners first

The Watchman is a small device implanted in your heart to reduce stroke risk if you have atrial fibrillation (an irregular heartbeat). Medicare Part B covers the procedure itself, the device, and the implantation surgery — but the coverage comes with real limits. You must have documented atrial fibrillation, a reason you cannot take blood thinners long-term, and a cardiologist's recommendation. Medicare will not pay if you straightforward prefer the device to medication.

The procedure typically costs between $30,000 and $50,000 before insurance, though the exact amount varies by hospital and region. With Medicare coverage, you pay your Part B deductible (which changes yearly) plus 20 percent of the approved amount after that. If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower.

Key Takeaways

  • Medicare Part B covers the Watchman device and implantation surgery only if you have atrial fibrillation and cannot safely take blood thinners long-term.
  • Your cardiologist must document why blood thinners are not an option for you — intolerance, bleeding history, or another medical reason — before Medicare will consider the procedure.
  • You will owe your Part B deductible plus 20 percent coinsurance of the approved amount, which varies by hospital and region.
  • The implanting hospital must be Medicare-approved and the cardiologist must be board-certified in cardiology or interventional cardiology.
  • Medicare requires a waiting period after implantation before you can stop blood thinners entirely, typically 45 days for most patients.

What Medicare requires before approving the Watchman

Medicare does not cover the Watchman as a first choice. You must have tried anticoagulant blood thinners (such as warfarin, apixaban, or dabigatran) and have a documented medical reason you cannot continue them. That reason might be a serious bleeding event, an allergy, kidney disease that makes certain thinners unsafe, or a condition that makes the blood thinner ineffective. Your cardiologist must write this reason in your medical record before the procedure is scheduled.

You also need a confirmed diagnosis of atrial fibrillation. This is usually documented through an electrocardiogram (EKG) or heart monitor reading. Medicare will not cover the Watchman for patients with paroxysmal atrial fibrillation (episodes that come and go) unless you have had at least one documented episode within the past 12 months.

The implanting center must be a hospital or accredited surgical facility that Medicare recognizes. Not all hospitals perform this procedure, so your cardiologist will refer you to one that does. The cardiologist performing the implantation must be board-certified in cardiology or interventional cardiology.

What you pay out of pocket

Your costs depend on whether you have reached your Part B deductible for the year. The Part B deductible changes annually — in 2024 it was $240, but confirm the current year's amount on Medicare.gov. Once you meet the deductible, Medicare pays 80 percent of the approved amount and you pay 20 percent coinsurance.

The approved amount is not the same as the hospital's list price. Medicare negotiates rates with each facility, so the approved amount varies by region and hospital. A hospital in a high-cost area may have a higher approved amount than one in a lower-cost area. Ask the hospital's billing department for an estimate of the approved amount before your procedure so you can calculate your 20 percent share.

If you have a Medigap plan (supplemental insurance), it typically covers some or all of your coinsurance, depending on which plan you hold. If you have a Medicare Advantage plan, your out-of-pocket maximum and coinsurance rules are set by your plan, not by Medicare. Contact your plan directly for a cost estimate specific to your coverage.

The waiting period and blood thinner transition

After the Watchman is implanted, you cannot stop blood thinners when ready. Medicare and the device manufacturer require a waiting period during which you continue anticoagulation while the device integrates into your heart tissue. For most patients, this period is 45 days. Some patients with certain risk factors may need to stay on blood thinners longer — your cardiologist will determine this based on your individual situation.

During the waiting period, you will have a follow-up ultrasound (called a transesophageal echocardiogram, or TEE) to confirm the device is in the correct position and that no blood clots have formed around it. This ultrasound is also covered by Medicare Part B. After the waiting period and successful ultrasound, you can stop blood thinners under your cardiologist's supervision.

How to learn about your specific situation qualifies

The only way to know whether Medicare will cover the Watchman for you is to have your cardiologist review your medical history and atrial fibrillation diagnosis. Bring your recent test results, a list of blood thinners you have tried, and documentation of any bleeding events or intolerances. Your cardiologist can then contact Medicare or check the current coverage rules to determine whether your case meets the criteria.

You can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227) and ask about Watchman coverage. Have your medical history and diagnosis information ready. Medicare representatives can tell you whether your situation is likely to be covered, though they cannot make a final information — only the hospital's billing department and Medicare can do that after you are referred.

Medicare Advantage plans and the Watchman

If you are enrolled in a Medicare Advantage plan instead of Original Medicare, your coverage for the Watchman may differ. Some Medicare Advantage plans cover the procedure under the same conditions as Original Medicare, while others may have additional requirements or higher out-of-pocket costs. A few plans may not cover it at all.

Contact your Medicare Advantage plan's customer service number (on your insurance card) and ask specifically whether the Watchman procedure is covered and what your out-of-pocket costs would be. Ask them to put the answer in writing so you have documentation. If your plan does not cover the procedure or charges more than you can afford, you have the option to switch to Original Medicare during the annual enrollment period (October 15 to December 7 each year).

What happens if Medicare denies coverage

If Medicare denies coverage for the Watchman, you have the right to appeal. The hospital's billing department or your cardiologist's office can help you file an appeal, which involves submitting additional medical documentation that explains why you cannot take blood thinners. Many denials are overturned on appeal if the medical record clearly shows a contraindication to anticoagulation.

If the appeal is denied and you still want the procedure, you can choose to pay out of pocket. Some hospitals offer payment plans or financial information programs for uninsured or underinsured patients. Ask the hospital's financial counselor about these options before deciding.

Frequently Asked Questions

Does Medicare cover the follow-up ultrasound after the Watchman is implanted?

Yes. The transesophageal echocardiogram (TEE) performed 45 days after implantation to confirm the device is in place is covered by Medicare Part B. You will owe your coinsurance (20 percent of the approved amount) for this test, just as you do for the implantation procedure itself.

What if I have atrial fibrillation but have never taken a blood thinner?

Medicare will not cover the Watchman if you have not tried blood thinners first. You must have a documented medical reason — such as bleeding, allergy, or intolerance — that prevents you from taking them. If you have never taken one, your cardiologist will likely recommend trying one before considering the Watchman.

Can I get the Watchman at any hospital?

No. The hospital must be Medicare-approved and must have cardiologists trained in Watchman implantation. Your cardiologist will refer you to a facility that performs the procedure. If the nearest approved facility is far from your home, ask your cardiologist whether there are other options in your area.

Will my Medigap plan cover the 20 percent coinsurance?

Most Medigap plans cover some or all of the coinsurance for hospital procedures, but it depends on which plan you have. Plans C, D, F, G, M, and N typically cover coinsurance; Plans A, B, K, and L cover it partially. Check your plan documents or call your Medigap insurer to confirm what they will pay.

What if I switch to a Medicare Advantage plan after the Watchman is implanted?

You can switch plans during the annual enrollment period. Your new plan must cover the follow-up care and monitoring you need after implantation. Before switching, contact the new plan and confirm they cover post-Watchman cardiology visits and imaging. If they do not, you may want to stay with your current plan or switch back to Original Medicare.