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Does Medicare Cover Hernia Surgery?

Christian Worstell by Christian Worstell    |    Published Oct 22, 2019    |    Reviewed by John Krahnert

Yes, Medicare helps cover hernia surgery in most cases. Medicare Part B generally covers 80 percent of the cost of outpatient medical services, like hernia surgery, after you meet your deductible.

This cost may include a physician fee, facility services, anesthesia and prescription drugs for post-surgery pain relief.

A Medigap policy can help pay for your coinsurance costs, and some even cover your Part B deductible.

Doctors consulting in hallway

How Much Does Medicare Cover for Surgery?

Hernia repair is typically performed on an outpatient basis. As long as it’s deemed medically necessary, Medicare Part B should help pay for the costs.

  • After you meet your deductible ($185 in 2019), Part B operates on an 80/20 coinsurance. Medicare pays 80 percent of the cost, you pay the remaining 20 percent.

  • Let’s assume your inguinal hernia repair costs $5,000. After you meet your $185 deductible, you Medicare Part B would pay $4,000 for your surgery and you would be responsible for $1,000 ($1,185 total with the deductible).

  • In addition to a physician fee and facility services, the total cost of hernia surgery may include the price of anesthesia and drugs for post-surgery pain relief.

If your surgery requires a hospital stay, keep in mind that Medicare Part A’s coverage and cost-sharing would factor into your out-of-pocket costs.

Medicare Part A carries a deductible of $1,364 per benefit period in 2019, and long hospital stays — though unlikely for a hernia repair — can be expensive. You would still be responsible for any Part B cost-sharing that is incurred.

Medicare Supplement Plans Can Help Pay Your Out-Of-Pocket Hernia Surgery Costs

A Medicare Supplement Insurance policy, also known as Medigap, will pay for certain expenses that Medicare leaves behind. There are 10 standardized Medigap policies, and each offers a different combination of basic benefits.

All Medigap plans cover your Part A and Part B coinsurance to a certain degree. And more comprehensive plans even help pay for your Part A and Part B deductibles.

This could substantially lower the out-of-pocket costs associated with your hernia surgery.

Before undergoing hernia repair, talk to your health care provider about the services and supplies that your hernia surgery will entail.

Ask why these services and supplies are required and how much each one will cost, then contact your insurance provider to see which ones are covered by your program. 

Find a Medigap Plan to Help Cover Your Hernia Surgery Costs

Call today to speak with a licensed insurance agent who can help you find Medigap plans available in your area. An agent can help you find a plan that fits your health coverage needs and your budget.

 

Find Medigap plans in your area.

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Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.

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