How to Get Health Insurance With a Pacemaker [2024]
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Jimmy McMillan
Licensed Insurance Agent
Jimmy McMillan is an entrepreneur and the founder of HeartLifeInsurance.com, an independent life insurance brokerage. His company specializes in life insurance for people with heart problems. He knows personally how difficult it is to secure health and life insurance after a heart attack. Jimmy is a licensed insurance agent from coast to coast who has been featured on ValientCEO and the podcast...
Licensed Insurance Agent
UPDATED: Jan 9, 2024
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UPDATED: Jan 9, 2024
It’s all about you. We want to help you make the right coverage choices.
Advertiser Disclosure: We strive to help you make confident insurance decisions. Comparison shopping should be easy. We are not affiliated with any one insurance provider and cannot guarantee quotes from any single provider.
Our insurance industry partnerships don’t influence our content. Our opinions are our own. To compare quotes from many different insurance providers please enter your ZIP code above to use the free quote tool. The more quotes you compare, the more chances to save.
On This Page
It is possible to obtain health insurance with a pacemaker, but it will depend on your age, your health status, where you live, and your employment status/income level.
If you are over age 65, you should qualify for Medicare and you would most likely obtain a supplemental policy for your pacemaker care. If you are under 65, it will depend on what state you live in and your employer and/or income level.
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Insurance Options for Pacemaker Patients
If you are under 65 and offered health insurance through your employer, often times they have a group plan which accepts all employees, regardless of their health history.
If you are employed and your employer does not offer health insurance, you might have more difficulty obtaining a policy. This is also true if you are self-employed and seeking private health insurance.
States vary widely as far as private health insurance coverage is concerned. Their rules and conditions even differ between counties. For example, in some states, private health insurance companies will offer you health coverage when you have a pacemaker only if you are coming off COBRA within a certain time period or if you have been dropped from a state health program.
In other states, there is a selection of private health insurance companies willing to provide you with full health care coverage, but at a steep cost.
When you have a pacemaker, it is considered a pre-existing medical condition. If you are under the age of 65, it is often very difficult or extremely expensive to secure full health care coverage with a private health insurance company with a pre-existing condition.
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Pre-existing Medical Conditions
When your employer does not offer health insurance or you are self-employed and seeking health insurance, potential private health insurance providers will have you fill out a medical history report. Health insurance providers will sometimes have you fill this out even if your employer is offering you health coverage through a group plan.
A medical history report will ask you what illnesses or diseases you have or have been treated for in the past, the types of surgeries you have had, your family’s health history, and any other medical condition you have or have had to determine if you have a pre-existing medical condition.
A pre-existing medical condition is any type of illness, injury, surgery, disease or medical condition that you have now or have had in the past. When you have a pre-existing medical condition, health insurance providers are reluctant to cover the health care costs associated with the illness, disease, or condition. Having a pacemaker constitutes a pre-existing condition and therefore puts you in this category and the increased health insurance rates that go with it.
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Medical Release of Records
Health insurance companies normally do not deny coverage for a pre-existing condition without requesting further information from you and your medical health care provider(s). In most cases, health insurance companies will request you to sign a form to release your medical records and health history information from each doctor or medical professional that has treated your pre-existing condition. They then acquire these records to have them evaluated by a qualified health care professional. In doing so, they are trying to calculate your current status as a healthy individual while at the same time assessing their risk in providing you with health care coverage.
It is not guaranteed that health insurance providers will offer standard coverage to patients with a pre-existing condition like a pacemaker. However, health insurance companies may offer you a policy that covers everything but your pacemaker-related health care, or they may offer you complete health care insurance at a high cost. The type and extent of your health care coverage is going to depend largely on the state in which you live and the health insurance company you elect.
Health Insurance Coverage with Your State
Even if you fail to gain private health insurance coverage for your pre-existing condition, you may be eligible to obtain it through your state. Most states today offer health insurance coverage to residents under age 65 who are in within a certain income bracket. As with private health insurance carriers, states vary widely in their rules and conditions for health insurance coverage. You may inquire with your state health department to see if you qualify for reduced-rate or free health coverage through your state.
Before you choose a health insurance provider, make sure that you are getting all the health care coverage you will need to maintain your health. You can explore your options from different private health insurance providers right now by getting online insurance quotes.
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Case Studies: How to Get Health Insurance With a Pacemaker
Case Study 1: John’s Journey
John, a 55-year-old with a pacemaker, struggled to find insurance covering his device, leading him to seek help from a healthcare advocate. Together, they gathered medical documentation and highlighted the pacemaker’s necessity, resulting in John securing insurance that included his device. The advocate’s guidance proved instrumental in achieving John’s successful coverage.
Case Study 2: Sarah’s Success Story
Sarah, a 40-year-old with a pacemaker, faced insurance coverage issues after changing jobs. Her new employer’s plan excluded pacemaker coverage, but Sarah proactively approached the HR department for a solution. With their assistance, an exception was made within the insurance plan to cover her pacemaker-related expenses.
Case Study 3: Mark’s Mediation
Mark, a 62-year-old with a pacemaker, encountered obstacles when his insurance provider denied coverage for a replacement. He pursued mediation and, with the support of his healthcare provider, negotiated a favorable settlement. Eventually, the insurance company agreed to cover the cost of the pacemaker replacement, resolving Mark’s challenging situation.
Case Study 4: Emily’s Expert Guidance
Emily, a 35-year-old with a pacemaker, faced insurance rejections due to her pre-existing condition. Seeking a solution, she consulted an insurance broker experienced in high-risk cases. The broker evaluated Emily’s medical history and recommended suitable insurance providers, ultimately leading her to secure coverage that included her pacemaker and other medical needs.
Case Study 5: David’s Dedication
David, a 50-year-old with a pacemaker, faced repeated rejections for health insurance due to his pre-existing condition. He persevered and conducted thorough research, leading him to find a state-sponsored program specifically catering to individuals with pre-existing conditions. David enrolled successfully, securing coverage for his pacemaker and ongoing medical needs.
Frequently Asked Questions
Can I get health insurance coverage if I have a pacemaker?
Yes, you can get health insurance coverage even if you have a pacemaker. Having a pacemaker is considered a pre-existing condition, but insurance companies are generally required to provide coverage for individuals with pre-existing conditions, including those with pacemakers.
How can I obtain health insurance coverage with a pacemaker?
Here are some options to consider when seeking health insurance coverage with a pacemaker:
- Employer-Sponsored Plans: If you are employed, check if your employer offers health insurance coverage. Many employer-sponsored plans provide coverage for pre-existing conditions, including pacemakers.
- Government Programs: Explore government-funded health insurance programs such as Medicaid (for low-income individuals and families) or Medicare (for seniors and certain individuals with disabilities). These programs typically cover pre-existing conditions.
- Health Insurance Marketplace: In countries with a health insurance marketplace, you can browse and purchase health insurance plans through the marketplace. These plans are offered by private insurance companies and may provide coverage for pre-existing conditions.
- Individual Health Insurance: If you don’t have access to employer-sponsored plans or government programs, you can purchase individual health insurance directly from insurance companies. Research and compare different plans to find one that covers pre-existing conditions, including pacemakers.
- Special Enrollment Period: If you recently had a pacemaker implanted or experienced a life event such as losing job-based coverage, you may be eligible for a special enrollment period. This allows you to enroll in health insurance outside of the regular enrollment period.
Will having a pacemaker affect my health insurance premiums?
Having a pacemaker may impact your health insurance premiums. Insurance companies consider various factors when determining premiums, including age, medical history, and pre-existing conditions. Since a pacemaker is a medical device that requires ongoing monitoring and potential maintenance, it may contribute to higher premiums. However, the specific impact on premiums can vary depending on the insurance company and the plan you choose.
Are there any specific health insurance plans for individuals with pacemakers?
There are no specific health insurance plans exclusively for individuals with pacemakers. However, many health insurance plans cover pre-existing conditions, including pacemakers. When comparing plans, review the coverage details and confirm that pre-existing conditions are included.
What documents or information do I need when applying for health insurance with a pacemaker?
When applying for health insurance with a pacemaker, you may be required to provide the following information:
- Medical Records: Provide copies of your medical records related to your pacemaker implantation, including the surgery details, post-operative care, and any relevant test results.
- Physician Information: Include the contact information for the physician who performed the pacemaker implantation and any other specialists involved in your care.
- Prescription Medications: List any prescription medications you take related to your pacemaker or other medical conditions.
- Treatment History: Provide details of any prior medical treatments or hospitalizations related to your pacemaker or cardiac health.
- Insurance History: If you previously had health insurance coverage, provide information about your previous plan, including the start and end dates.
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Jimmy McMillan
Licensed Insurance Agent
Jimmy McMillan is an entrepreneur and the founder of HeartLifeInsurance.com, an independent life insurance brokerage. His company specializes in life insurance for people with heart problems. He knows personally how difficult it is to secure health and life insurance after a heart attack. Jimmy is a licensed insurance agent from coast to coast who has been featured on ValientCEO and the podcast...
Licensed Insurance Agent
Editorial Guidelines: We are a free online resource for anyone interested in learning more about auto insurance. Our goal is to be an objective, third-party resource for everything auto insurance related. We update our site regularly, and all content is reviewed by auto insurance experts.