Does Medicare Cover Surgery?

Medicare typically does cover surgery that deemed medically necessary by a doctor. The part of Medicare (Part A or Part B) that covers your surgery will depend on the type of surgery and type of facility in which you undergo surgery.

Medicare Advantage (Part C) plans may also cover surgery that is deemed medically necessary by your doctor. Medicare Advantage plans also include an annual out-of-pocket spending limit, which Original Medicare (Part A and Part B) doesn’t offer.

This spending limit can save you money on certain out-of-pocket Medicare costs.

A man smiles and speaks with his doctor in the hospital

When does Medicare pay for surgery?

Medicare may cover expenses that arise from surgery that a doctor orders because it is necessary for your health and quality of life. Medicare does not cover elective or cosmetic surgeries, except in rare circumstances when they are for a specific medical purpose.

Depending on where you undergo surgery, Medicare Part A or Part B may cover some of your costs:

  • Medicare Part A helps cover your hospital and inpatient care costs related to your surgery.

  • Medicare Part B helps cover the costs for doctor’s services related to your surgery.

How much does surgery cost with Medicare?

Even if Medicare covers your surgery, there are some out-of-pocket costs you should expect to pay, which may include:

  • Part A deductible
  • Part A coinsurance
  • Part B deductible
  • Part B coinsurance or copayment

Medicare Part A deductible and surgery

The Medicare Part A deductible is $1,364 per benefit period in 2019. Benefit periods can occur more than once in a year, and the Part A deductible is not annual.

This means that if you are admitted for inpatient hospital care, you will need to meet your Part A deductible before your Part A coverage kicks in.

Once you are discharged and stop receiving inpatient care for 60 consecutive days, the benefit period ends.

If you are admitted for inpatient care again later in the same year (but after your first benefit period has ended), a new benefit period will start.

You will be required to meet the Part A deductible again before your Part A coverage will kick in for this new benefit period.

Medicare Part A coinsurance

Once you meet your Part A deductible in a benefit period, you will likely be responsible for Part A coinsurance costs:

  • Days 1-60 spent in the hospital: $0 coinsurance for each benefit period
  • Days 61-90: $341 coinsurance per day of each benefit period in 2019
  • Days 91 and beyond: $682 coinsurance per each “lifetime reserve day” after day 90 for each benefit period in 2019
  • Beyond lifetime reserve days: you pay all costs

You cannot accrue any additional reserve days after your lifetime reserve days are gone.

Medicare Part B deductible

The Medicare Part B deductible is $185 per year in 2019.

Medicare Part B coinsurance or copayment

After your Part B deductible is met, you typically pay 20 percent of the Medicare-approved amount for most doctor’s services including appointments, checkups, and any post-op care.

There is no annual limit on how much you could pay for the Part B coinsurance in a given year.

Be sure to talk with your doctor for specific cost and coverage information related to your surgery.

Medicare Advantage plans can cover some surgery costs

Medicare Advantage Plans are an alternative to Original Medicare that are sold by private insurance companies.

Every Medicare Advantage plan is required to cover everything that Part A and Part B covers, including medically necessary surgeries. All Medicare Advantage plans include an annual out-of-pocket spending limit.

Because there is no limit to how much you could potentially pay for Part A and Part B coinsurance costs in a year, a Medicare Advantage plan with an out-of-pocket spending limit could potentially help you save on Medicare costs.

Most Medicare Advantage plans also cover prescription drugs, which are not typically covered by Original Medicare.

Some Medicare Advantage plans may also offer additional benefits, such as

Some Medicare Advantage plans may also offer benefits such as home-delivered meals when you are recovering from surgery. Availability of specific plans and benefits varies by location.

Learn more about the Medicare Advantage plans that may be available where you live by calling to speak with a licensed insurance agent.

 

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