Written by Joshua Malin
Reviewed by Lana Hambilton
Last updated 21/11/2023
It’s normal to feel uneasy about getting a pacemaker, but the procedure and cost aren’t as scary as you might think. Pacemaker surgery is a reasonably common, safe, and affordable medical procedure, with over 18,000+ pacemaker insertions taking place in Australia each year.1
Here are a few of the key details on how pacemakers work and what you can expect to pay:
A cardiac pacemaker is an electronic device threaded through the veins to the heart, comprising of wires, a battery, a pulse generator and a small computer.2 These devices help correct heart problems by sending electrical impulses to control your heart rate. A pacemaker can treat conditions such as:
However, it’s not the only type of implantable cardiac device. Artificial implantable cardioverter defibrillators (AICD) monitor for dangerous irregular heart rhythms and send an electric shock to manage a heart that’s in fibrillation (i.e. beating irregularly).3 Another type of pacemaker called a cardiac resynchronization therapy device (CRT) or a biventricular pacemaker assists people who have suffered from heart failure by stimulating both of the lower heart chambers.4
Our health insurance expert, Lana Hambilton, has some tips on how private health insurance could help with your pacemaker surgery.
Is it likely you’ll need a pacemaker in the near future? While you might pay a bit more for the premiums now, it may be best to look at policies with a lower excess. It could save you money in the long run, and you can always increase it at a later date.
If you need a pacemaker or similar device, the last thing you’ll want to worry about is whether your surgery is included on your policy, or if you’ve served all the relevant waiting periods. The waiting period could be up to 12 months for a pre-existing condition, so it’s a good idea to plan ahead. As such, it’s important to make sure you’ve got the right policy for your needs. It pays to compare your health insurance on a regular basis or as your circumstance change.
If you’re planning to be admitted to hospital for pacemaker surgery, it’s a good idea to contact your health fund for a list of doctors and specialists who align with their gap cover agreements. In many instances, you will only incur a minimal gap or potentially none at all if the healthcare provider participates in your fund’s gap cover scheme.
Most healthcare providers consider pacemaker implantation to be a relatively minor surgery, and it’s usually priced as such. For patients privately insured for this procedure who were treated in a private hospital, around 50% had no out-of-pocket doctors fees for their pacemaker surgery.5 The typical out-of-pocket cost for the other 50% was only $50. While this doesn’t include hospital fees, which average around $17,000, most or all of your hospital costs can be covered by your health fund.
While the procedure cost is quite reasonable, there may be other costs that you need to consider, which will vary based on your circumstances and policy. For example:
Procedure and insurance costs only apply if you’re being treated as a private inpatient. If you’re treated as a public patient, Medicare will cover the total cost of your surgery. However, this will also mean:
The typical cost paid towards private patient pacemaker insertion surgery (which is typically paid by private health insurers, provided the patient has an appropriate level of cover) for accommodation, theatre and medical device fees is $17,000.5 Pacemaker costs for private patients may exceed what the fund pays and you may need to pay any gap and excess costs as well as incidentals (e.g. WiFi, Foxtel etc.), but that’s where those costs end.
Ultimately, it’s up to you whether you want to go public or private. However, it might be worth it if you’d like to choose your own doctor, recover in a private room (if available) and avoid the public system’s waiting lists. In short, with private health insurance, you can undertake the procedure on your terms.
If you’re trying to figure out which policies might suit your particular health needs, read our explanation of the different private hospital insurance categories. It will explain which tiers cover which services and can help you decide whether this purchase suits your needs.
As Head of Health, Life, and Income Protection Insurance at Compare the Market, Lana Hambilton is passionate about simplifying the comparison process and educating Australians about the value and benefits private health insurance can offer and the critical role it plays in our medical system. She firmly believes that health insurance provides choice in one of the most important aspects of life – our health – and has experienced countless cases over the years where peace of mind comes through the ability to choose when, where, and who will treat you.
Lana has 15 years’ experience in the health insurance and insurance comparison industries. She’s also a Board Member of the Private Health Insurance Intermediaries Association.
1 Australian Institute of Health and Welfare – Heart, stroke and vascular disease—Australian facts. Last updated June 2023. Accessed November 2023.
2 Healthdirect, Pacemaker. Last updated October 2022. Accessed November 2023.
3 Mayo Clinic – Implantable cardioverter defibrillators. Last updated August 2023. Accessed November 2023.
4 Mayo Clinic – Cardiac resynchronization therapy. Last updated July 2023. Accessed November 2023.
5 Department of Health, Medical Costs Finder. Accessed November 2023.
