Is a Pacemaker Covered by Insurance in India?

Pacemaker Treatment & Health Insurance in India: A Complete Guide

A pacemaker is a small medical device used to regulate the heart rhythm, especially in cases of heart failure. The implantation of a pacemaker is also often expensive, which necessitates the need for proper health insurance coverage.

Since most health insurance policies cover various diseases and treatments, it is also crucial to understand whether pacemakers are covered under such policies. Keep reading to learn whether health insurance covers pacemakers and more details.

Does Health Insurance Cover the Cost of a Pacemaker?

In India, pacemaker implantation is usually covered by health insurance. This is because it's a medically required procedure to treat serious arrhythmias. Health insurance policies cover the entire cost of pacemaker surgery.

This includes the device, the surgical procedure, the hospital stay, medications, and follow-up consultations. Coverage terms, such as waiting periods, sub-limits, or pre-authorisation requirements, may apply depending on the insurer. It is, therefore, crucial to review policy wording carefully.

What is the cost breakdown of a pacemaker in India?

The cost of pacemaker surgery in India varies based on factors such as the type of pacemaker, the hospital's location, and the patient's medical condition. On average, the total expense ranges from ₹180,000 to ₹350,000. The device itself can cost between ₹45,000 and ₹300,000.

For instance, in cities like Hyderabad, the surgical cost typically falls between ₹250,000 and ₹350,000. Additional costs of a pacemaker surgery in India include:

• Surgeon's Fee: Varies based on experience and hospital.
• Hospital Charges: Includes room rent, equipment usage, and staff services.
• Pre- and Post-Surgery Care: Diagnostic tests, medications, and follow-up consultations.
• Complications: Any unforeseen medical issues can lead to increased costs.

Disclaimer: Please note that all prices listed above are estimates only and may vary depending on the healthcare centre.

What is the Need for Health Insurance for a Pacemaker Surgery in India?

Pacemaker surgery in India typically costs between ₹2 lakhs and ₹3.5 lakhs, depending on the type of device, hospital, and city. These figures emphasise the potential financial impact of such surgery. The factors that necessitate insurance coverage for a pacemaker surgery are as follows:

1. Protecting Against High Medical Expenses : Patients with heart rhythm disorders require a permanent pacemaker. The combined costs of hospitalisation, surgeon fees, device prices, and diagnostics can quickly add up. Insurance protects families against having to pay large sums of money out of pocket all at once. This reduces immediate financial stress.
2. Coverage for Pre- and Post-Operative Care : Not only surgery, but also diagnostics, medications, hospital stays, and follow-up care are often covered by insurance policies. These packages offer comprehensive coverage, including surgery and all related care.
3. Peace of Mind : Knowing that your insurance will cover the pacemaker and any associated costs is a great comfort when a serious heart condition strikes. Insurance is a great way to ensure access to high-quality medical services in India at lower prices compared to those in Western countries.
4. Avoiding Debt and Financial Hardship : India's healthcare system still heavily relies on out-of-pocket payments. Patients are responsible for nearly half of all medical costs, which can lead to debt and poverty. Insurance breaks this cycle by providing financial assistance when needed.
5. Inclusive Cardiac Health Plans : In India, many health insurance policies or heart disease plans explicitly cover pacemaker implants if medically necessary. For example, the policies offered by Star Health Insurance for heart illness.

Pacemaker surgery is not only a medical procedure that requires considerable attention, but it also has significant financial implications. Therefore, it is essential to have health insurance to protect your health and finances in the long term.