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You may feel a certain amount of trepidation around getting a pacemaker, but both the procedure and cost can be quite reasonable. We’re happy to explain more about the topic.

What is a pacemaker?

If an individual has an irregular heart rhythm, cardiac pacemakers can be implanted to help manage this condition by sending electric impulses to the heart. Standard pacemakers are comprised of a bunch of wires threaded through veins to the heart, a battery and pulse generator, and a small computer.1

However, it’s not the only type of device that may be implanted into individuals. Artificial implantable cardioverter defibrillators, or AICD’s, look out for dangerous irregular heart rhythms. It can send an electric shock to manage a heart that is in fibrillation (i.e. beating irregularly).

What is the cost of pacemaker surgery?

For all intents and purposes, implanting a pacemaker is considered relatively minor surgery, according to multiple sources.1,2 Better still, it tends to be priced as such.

 

More than two in five patients paid $0 for doctors’ and other health provider costs related to a pacemaker insertion.

Of those private patients that underwent this procedure and did pay out of pocket cost, here is what was owed (on average):

ProcedureAmount paid for doctors’ and provider costs*
Cardiac pacemaker: surgery for insertion, removal or replacement of a small device in the chest to help control heart rhythm (MBS item 38353)3$50
ProcedureAverage gap (i.e. out of pocket costs) when it was paid
Defibrillator: procedure to implant or replace AICD (total system), minor complexity4$330
* Figures cited are the typical amount paid after Government and insurer payments (i.e. an excess or co-payment may still be owed). Does not include hospital charges (e.g. accommodation, theatre, medical device costs).

Source: Department of Health, financial year 18/19

For the aforementioned treatments, there may be other costs you may need to pay, which will vary based on your circumstances and policy.

  • Excess. An excess is a one-off per year cost you pay when you claim on your private hospital insurance. You decide what amount this excess will be (or whether you’ll pay it at all) when choosing your hospital insurance. For example, you might pay $250 for your claim.
  • Co-payment. A co-payment can be a charge paid every day of your stay in the hospital to your insurer often up to a capped amount. For example, you may pay $50 each day you’re admitted as a private hospital patient.
  • Miscellaneous costs. While we can’t predict what these might be for you, it’s important to consider the ancillary costs of undergoing such a procedure: parking, babysitting, loss of income if you need to take a few weeks off work, etc.

However, these costs only apply if you’re being treated as a private patient. If you’re treated as a public patient in a public hospital you will pay nothing for your procedure. However, this will mean:

  • you must enter the public waiting list for this procedure, which is typically longer than the private system;
  • you cannot choose your doctor; and
  • you would be unlikely to stay in a private room.

The above procedure cost breakdown shows what some Australians have paid, but it’s not necessarily an indication of what you will pay. Talk to your doctor or your health insurer about the cost of treatment before you make any decisions.

Is it worthwhile taking out private hospital insurance for pacemaker procedures?

In all, the typical amount that private health insurers paid for accommodation, theatre and medical device fees totalled $18,000. Pacemaker costs for private patients will include any gap and excess costs, as well as incidentals eg. accommodation, but that’s where those costs end.

It can be worth it because you get to choose your own doctor, you can recover in a private room (should it be available) and you avoid the waiting periods of the public system. In short, 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 private hospital insurance categories. It will explain which tiers cover which services, which can help you decide whether this purchase suits your needs.

 

Sources
  1. gov.au, Pacemaker (published 2018)
  2. S. Department of Health & Human Services, Pacemakers (accessed Jan 2020)
  3. Department of Health, Medical Costs Finder (published 2019)
  4. Department of Health, Hospital Casemix Protocol Annual Report (data from 2018-19)

So, what are you waiting for?

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