Medicare does help cover hernia surgery as long as it is considered medically necessary by a doctor.
Medicare Advantage (Part C) plans also cover hernia surgery when it is medically necessary. Medicare Advantage plans include an annual out-of-pocket spending max, which could protect you from thousands of dollars in Medicare costs.
Original Medicare (Part A and Part B) does not offer an out-of-pocket spending cap.
Medicare Advantage plans provide the same hospital and medical benefits as Medicare Part A and Medicare Part B. Therefore, your hernia surgery will be covered by a Medicare Advantage plan as long as it meets Medicare’s requirements for coverage.
Most Medicare Advantage plans also provide coverage for prescription drugs, and many plans provide coverage for benefits that aren’t covered by Original Medicare, such as:
Some Medicare Advantage plans also offer coverage for non-emergency transportation and certain over-the-counter (OTC) products.
Generally, hernia surgery is covered by Medicare Part B (medical insurance) and is performed on an outpatient basis.
Medicare Part B typically covers 80 percent of the cost of hernia surgery, and you pay 20 percent once your Part B deductible is met. In 2019, the Medicare Part B deductible is $185 per year.
This means that before Medicare Part B will cover any costs related to your surgery, you must pay (or have already paid) your $185 deductible for the year.
In the rare case that your hernia surgery requires a hospital stay, your hospital care would be covered by Medicare Part A (hospital insurance). Your Part A cost-sharing would apply in addition to your Part B costs.
In 2019, Medicare Part A has a deductible of $1,364 per benefit period.
We want you to get the most from your Medicare coverage, and our licensed agents are happy to help you explore and compare Medicare Advantage plans in your area.
Find a Medicare Advantage plan that covers hernia surgeryCompare Plans
Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.
Copyright © 2019 TZ Insurance Solutions LLC. All rights reserved.
MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.
Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
Medicare has neither reviewed nor endorsed this information.