Does Medicare Part A Cover Outpatient Surgery?

• by Christian Worstell
• August 23, 2023
• Reviewed by John Krahnert

Does Medicare Cover Outpatient Surgery?

Medicare Part A typically covers inpatient surgery but usually doesn't cover outpatient operations.

Medicare Part B typically covers outpatient services, including doctor’s visits and outpatient surgery that is medically necessary.

Medicare Advantage (Part C) plans also cover outpatient surgery, and they also include an annual out-of-pocket spending limit. This can potentially save you money in out-of-pocket Medicare costs for your surgery.

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

Is surgery covered by Medicare Part A?

Medicare Part A is hospital insurance, and it helps cover the costs of your inpatient stays at certain facilities, such as:

• Hospitals
• Skilled nursing facilities
• Mental health facilities

If you receive surgery that requires an inpatient hospital stay, Medicare Part A will help cover your hospital costs after you meet your Part A deductible ($1,600 per benefit period in 2023).

If you receive a medically necessary surgery as an outpatient, Medicare Part B is responsible for covering some of the costs of your doctor’s services.

How much does outpatient surgery cost with Medicare?

Generally you'll pay 20% of that medicare approved amount regarding your surgery, and then an additional 20% of the costs for your doctor. The Part B deductible is $226 in 2023, so once you hit the deductible then Part B coverage will kick in.

If Medicare Part B covers your outpatient surgery, you may still be responsible for certain out of pocket costs. 

• Part B deductible
• Part B coinsurance or copayment

Medicare Part B deductible for outpatient costs

The Medicare Part B deductible is $226 per year in 2023. You must meet this deductible before Medicare Part B coverage kicks in and covers your surgery costs for the rest of the year.

Medicare Part B coinsurance or copayment

After your Part B deductible is met through expenses you accrue as an outpatient, you usually are responsible for 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. This means that your Part B outpatient surgery coinsurance costs could add up quickly.

Medicare Advantage plans include annual out-of-pocket spending limits

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. This means that if your outpatient surgery is covered by Medicare Part B, it will also be covered by a Medicare Advantage plan.

The annual out-of-pocket spending limit that is included with all Medicare Advantage plans could potentially help you save money on your out-of-pocket costs related to outpatient surgery.

Call to speak with a licensed insurance agent today to learn more about Medicare Advantage plans in your area that may help cover your outpatient surgery and find out if you’re eligible to enroll.

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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