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.

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.

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 2023, the Medicare Part B deductible is $226 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 $226 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 2023, Medicare Part A has a deductible of $1,600 per benefit period.

Compare Medicare Advantage plans in your area

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.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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