Does Medicare Cover Hernia Surgery?

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.

Doctor talks with his patient in hospital office

Medicare Advantage plans and hernia surgery coverage

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.

Hernia surgery costs with Medicare

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.

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