Does Medicare Cover a Hysterectomy?

Medicare typically covers medically-necessary hysterectomies. Medicare Advantage plans also cover hysterectomies and include an annual out-of-pocket spending limit, which Original Medicare doesn’t offer.

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

Medicare Advantage (Part C) plans can also cover a hysterectomy that is deemed medically necessary by your doctor, and they also include an annual out-of-pocket spending limit. This can potentially save you money in Medicare costs for your hysterectomy.

Original Medicare does not include an out-of-pocket spending limit.

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How does Medicare cover hysterectomy surgery?

A hysterectomy is a surgical operation that removes all or part of the uterus and can help treat several medical conditions related to a woman’s health.

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

  • The hospital and inpatient care costs related to the hysterectomy are typically covered by Medicare Part A (Hospital Insurance).

  • Any doctor’s services related to the hysterectomy are typically covered by Medicare Part B (Medical Insurance).

How much does a hysterectomy cost with Medicare?

Even if Medicare covers your hysterectomy, 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

The Medicare Part A deductible is $1,364 per benefit period in 2019.

The Part A deductible is not annual, and you could experience more than one benefit period in a given calendar year.

Medicare Part A coinsurance

After you meet your Part A deductible in a benefit period, you could face 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

Once you use your lifetime reserve days, they are gone. You cannot accrue any additional reserve days.

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.

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

We recommend speaking with your doctor directly for specific cost and coverage information.

Medicare Advantage plans can cover some surgery costs

Medicare Advantage plans are sold by private insurance companies as an alternative to Original Medicare (Medicare Part A and Part B).

Every Medicare Advantage plan must cover everything that Part A and Part B covers, and most Medicare Advantage plans cover prescription drugs.

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

If your hysterectomy is covered by Original Medicare, it will also be covered by a Medicare Advantage plan.

A licensed insurance agent can help you find Medicare Advantage plans in your area.

 

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