A pacemaker can be a life-saving device for individuals suffering from heart rhythm disorders, but the cost of the procedure can be a significant concern, especially for seniors. If you’re enrolled in Medicare, understanding your coverage and out-of-pocket costs is essential. In this guide, we’ll explore how much a pacemaker costs with Medicare, what parts of Medicare cover it, and how much you might expect to pay out of pocket.
What Is a Pacemaker?
A pacemaker is a small medical device implanted under the skin near the chest to help control abnormal heart rhythms. It sends electrical impulses to prompt the heart to beat at a normal rate. The device is often recommended for conditions like bradycardia (slow heart rate) or heart block.
What Does Medicare Pay for a Pacemaker?
Medicare covers pacemaker procedures under Part A and Part B:
- Medicare Part A covers inpatient hospital costs if the surgery requires hospitalization.
- Medicare Part B covers doctor visits, diagnostic tests, and the surgical procedure if it’s done on an outpatient basis.
In most cases, Medicare will cover:
- The device itself (pacemaker)
- Surgical implantation
- Hospital and facility fees
- Follow-up visits and monitoring
Medicare typically covers 80% of the approved costs after you’ve met your Part B deductible (which is $240 in 2025). The remaining 20% is your responsibility unless you have supplemental insurance (Medigap) or a Medicare Advantage Plan.
How Much Does a Pacemaker Cost Out of Pocket?
The total cost of a pacemaker surgery can range between $20,000 and $60,000 depending on the hospital, the type of device, and your location. With Medicare:
- Medicare pays 80%, so they may cover around $16,000 to $48,000.
- You may pay 20%, which could range from $4,000 to $12,000, if you don’t have additional coverage.
If you have a Medigap plan, most or all of your 20% coinsurance may be covered. Medicare Advantage (Part C) plans vary by provider but may offer lower copayments and maximum out-of-pocket limits.
Why Would Medicare Deny a Pacemaker?
Medicare may deny coverage for a pacemaker if:
- The procedure is not deemed medically necessary.
- There is insufficient documentation from your healthcare provider.
- The patient does not meet Medicare’s criteria for pacemaker implantation.
To ensure approval, your doctor must submit the required clinical evidence that justifies the need for the device, such as results from an EKG, Holter monitor, or symptoms of bradycardia or syncope (fainting).
How Long Can a 70-Year-Old Live With a Pacemaker?
A 70-year-old patient who receives a pacemaker can live a full and active life, often well into their 80s or 90s. Pacemakers typically last 5 to 15 years before needing replacement. The lifespan depends on:
- The type of device
- Battery usage
- Overall health and comorbidities
Regular follow-ups with your cardiologist will ensure that the device functions properly and prolongs life expectancy.
Tips to Reduce Out-of-Pocket Costs
- Choose in-network providers to ensure Medicare-approved rates.
- Consider Medigap or Medicare Advantage plans to lower costs.
- Apply for financial assistance programs if eligible.
- Ask about the type of pacemaker and explore cost differences.
Final Thoughts
So, how much does a pacemaker cost with Medicare? While Medicare significantly reduces the financial burden of pacemaker implantation, you may still have out-of-pocket costs ranging from a few thousand dollars unless you have supplemental insurance. Always consult your healthcare provider and insurance plan to get a personalized estimate and ensure coverage approval.
