Yes, Medicare typically covers back surgery that is considered medically necessary by a doctor.
How much you will pay out of pocket for your back surgery depends on the procedure, where you receive the surgery, and how you get your Medicare benefits.
If your doctor deems your back surgery — or another type of surgical procedure — to be medically necessary, Medicare will generally provide coverage for the procedure.
Back surgeries can vary widely in cost. According to the chiropractic publication To Your Health, the cost of back surgery can cost as much as tens of thousands of dollars.1
With any medical procedure, make sure you ask your doctor what all is involved and how much it might cost.
What can you expect to pay out of pocket? It’s hard to say. If you are enrolled in Medicare Part A and Part B (Original Medicare), you can likely expect both to contribute to your care. Medicare Part A will help pay for costs associated with hospital inpatient stays and skilled nursing care, while Medicare Part B will help pay for the cost of the procedures itself, doctor fees, and other outpatient costs.
Medicare Part A and Part B each have their own deductibles, copayments and coinsurance that you could be responsible for paying.
If you receive your Medicare benefits from a Medicare Advantage plan, each plan has its own out-of-pocket costs and rules. Medicare Advantage plans do have an annual out-of-pocket limit — which means if you spend a certain dollar amount out of pocket for your care, your plan will pay 100% of the cost for covered services that go beyond the annual out-of-pocket limit. Original Medicare does not have an annual out-of-pocket limit.
You may need prescription medications to help you with the recovery process. You can receive prescription drug coverage through Medicare Part D. Part D benefits can be delivered from a stand-alone Prescription Drug Plan or a Medicare Advantage plan with Part D benefits. Out-of-pocket costs for prescription drugs can vary by plan.
It’s always a good idea to familiarize yourself with how your Medicare coverage works.
Laser spine surgery is a minimally invasive alternative to traditional back surgery. A doctor will make a small incision and use a laser or another type of instrument to treat the problem area. It may be effective for certain spinal conditions, but some patients may not be good candidates for the procedure.
Medicare may help pay for laser spine surgery if it is medically necessary. However, it may not help pay for facility fees – only doctor and procedure fees.2
A Medicare Advantage plan (also called Medicare Part C) is sold by a private insurance company and provides the benefits of Medicare Part A and Part B into one single plan.
Some Medicare Advantage plans may also offer additional benefits not covered by Original Medicare, which can include some costs savings if your plan will cover more of your out-of-pocket costs for back surgery.
Find out if a Medicare Advantage plan in your area is a good alternative to Original Medicare before you get back surgery. Give a licensed insurance agent a call at TTY Users: 711 today to learn more and to find a plan. We’re available 24 hours a day, 7 days a week.
1 Smith, J.C., MA, DC. Back Surgery: Too Many, Too Costly and Too Ineffective. (June, 2011). To Your Health. Retrieved from www.toyourhealth.com/mpacms/tyh/article.php?id=1447.
2 Laser Spine Institute. Common Questions. Retrieved from www.laserspineinstitute.com/patient-process/spine-back-questions.
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