Medicare Coverage of Surgery
Different parts of Original Medicare will cover different parts of your surgery costs.
Medicare Part A covers your hospital expenses, including the daily room cost and services, as well as the services of those physicians, nurses, and other providers.
Medicare Part B covers any medically necessary treatments associated with the surgery.
Lastly, Medicare Part D will cover your prescriptions.
In order for Medicare Part A or Medicare Part B to provide coverage for surgeries or procedures, the care must meet two basic requirements:
- The care must be “medically necessary.” An authorized medical provider must authorize the care, and Medicare must agree that it is necessary.
- A healthcare provider who participates in Medicare must perform or deliver the care.
Medicare does not cover any type of surgery deemed elective. This includes plastic surgery, unless needed to correct a medical problem. Medicare will not cover any type of surgery that is not considered medically necessary, nor any associated follow-up care. Medicare will also not cover any prescriptions, therapy or additional treatments that is necessary as a result of the elective surgery.
Cataract surgery, while often considered elective is, however, covered by Medicare. You will also be able to receive one pair of eyeglasses at this time. Otherwise, Medicare does not cover eyeglasses.
Medicare Supplement Coverage of Surgery
To know if your Medicare supplement will cover your surgery, you must simply know if Medicare covers the surgery. If Medicare covers a procedure, then your Medicare supplement covers the remaining portion that you would usually be left responsible for.
After you meet your deductible and pay the copayments, Medicare will cover 80% of your medical bills. You will still be responsible for the remaining 20%, Part A & B deductibles, coinsurance and copayments, unless you have a Medicare supplement.
If you do have a Medicare supplement, your supplement will cover most or all of these remaining expenses. The amount of coverage you receive will depend on which plan letter you have. For example, with a Plan F, you would walk away from a Medicare-approved surgery with zero out-of-pocket expenses.
Estimating Costs for Surgery
Estimating costs for surgery is quite difficult, as doctors may not know exactly which services you’ll need. If you’re having surgery, there are a few things you can do in advance to understand approximately how much you’ll pay.
- Ask the doctor, hospital, or facility how much you’ll have to pay for the surgery and any care afterward.
- Make sure you know if you’re an inpatient or outpatient, because what you pay may be different depending on your hospital status.
- Check with any other insurance you have (like a Medicare supplement) to see what it will pay. The amount covered will depend on which plan letter you have (i.e., Plan F, Plan G, etc.).
Medicare Supplement Coverage Can Help
Medical expenses can add up very quickly, especially with surgeries and procedures. By having a full coverage plan like Plan F or Plan G, you can avoid most or all out-of-pocket expenses.
If you’d like to view a quote from 30 of the top Medicare supplement insurance providers, please fill out this form. Better yet, give us a call at (866) 894-3258. One of our friendly agents will be available to help you find the coverage that best suits your specific needs.