Does Medicare Cover Surgery?
Medicare does cover the costs of many types of surgery, as long as they are considered medically necessary.
Since the overall costs vary from case to case, it’s important to understand what you might be expected to pay in out-of-pocket expenses, such as deductibles, copayments and coinsurance.
Medicare Supplement Insurance (Medigap) can help cover surgery costs that Medicare doesn't cover, including deductibles, copays and more.
What Surgery Costs Does Medicare Pay For?
Original Medicare (Medicare Part A and Part B) can cover different costs associated with inpatient and outpatient surgeries.
Medicare does not cover cosmetic surgery of any kind, unless it is deemed necessary by a doctor. For any surgery that Medicare does cover, Medicare beneficiaries must first meet their Part A and/or Part B deductible before Medicare benefits kick in.
Medicare Part A
Medicare Part A offers hospital insurance benefits, which include inpatient hospital stays associated with surgery. The deductible for Medicare Part A in 2021 is $1,484 for each benefit period.
If your surgery involves a hospital visit longer than 60 days, then you will be responsible for a $371 coinsurance payment per day after day 60 in 2021.
The Medicare Part A coinsurance rises to $742 per day for inpatient hospital stays of 91 days or more until your lifetime reserve day limit is reached.
Medicare Part B
Medicare Part B covers doctor’s services (like surgeries), preventative care, medical equipment, hospital outpatient services and more.
In 2021, the standard Part B premium is $148.50 per month, with a deductible of $203 per year. This deductible must be met before Part B coverage kicks in.
After you meet your Part B deductible, Medicare will typically pay for 80% of the approved amount for medical services. This means that you will likely be responsible for 20% of the costs associated with your surgery.
Medigap Can Help Pay for Out-of-Pocket Surgery Costs
Medigap, or Medicare Supplement Insurance, works with Original Medicare to cover some of the deductibles, copayments, and coinsurance associated with Original Medicare.
A Medigap plan could help you cover some of the costs associated with your surgery, which can add up quickly.
The following four basic benefits are covered by every Medigap plan:
Part A hospital care coinsurance
Part A hospice care coinsurance or copayment
Part B coinsurance or copayment
First 3 pints of blood needed for transfusion
There are five additional benefits that some plans may cover partially or completely.
A licensed agent can help you decide on a Medigap plan option that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live.
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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.