Will My Medicare Supplement Plan Cover Surgery?

When you find out that you need surgery, we know the last thing you want to worry about is whether or not your Medicare Supplement plan will cover it. Fortunately, when it comes to Medicare, your coverage is relatively straightforward. As long as Medicare pays for your treatment, your Medicare Supplement will pay for it as well. So, the real question you need to ask is, will Medicare cover your surgery?

How Do I Know if Medicare Will Cover My Surgery?

Medicare divides your coverage into three categories:

Medicare Part A – These are your inpatient services. If you are having a surgery that requires you to stay overnight, it will be covered by Part A.

Medicare Part B – Your outpatient services are categorized here. Surgery that does not require you to stay overnight, like cataract surgery, will fall under Part B.

Medicare Part D – The prescription medications that you take at home are under your Part D Drug Plan.

There are a few criteria you must meet for Medicare to cover your surgery:

  • Your doctor must state that your treatment is medically necessary
  • You must receive treatment from a practitioner that accepts Medicare
  • Your treatment must be a service that Medicare covers

Medicare will not cover any type of surgery that is not considered medically necessary, nor any associated follow-up care. For example, Medicare won’t pay for elective plastic surgery, but if you need facial reconstruction after an accident, you could receive Medicare-covered treatment. In addition, Medicare doesn’t cover any prescriptions, therapy, or additional treatments that are necessary as a result of the elective surgery. You can search for your treatment on Medicare’s website to see if it is Medicare-eligible.

How Much Will I Pay For My Surgery?

Before your surgery, there are three steps that you can take to help you predict approximately how much you will pay:

  • Confirm that your treatment aligns with what Medicare will cover by speaking with your doctor and the hospital. Be sure to ask if your surgery is considered inpatient or outpatient.
  • Review your Medicare Supplement plan coverage. You’ll want to know if you are responsible for expenses like copays, coinsurance, and deductibles. Medicare Supplement plans are all standardized, so you can check your coverage quickly and easily.
  • Review your Part D Drug Plan coverage. You can find out what your copay on prescriptions that you take at home will be. If you find that you have a high copay, there are several ways that you can spend less on pricey medications, without changing your drug plan.

My Doctor Has Recommended Follow-Up Treatment. Will My Medicare Supplement Cover That?

Many people have follow-up treatment or physical therapy recommended after surgery. If your doctor has recommended this to you, you can rest assured that as long as Medicare approves it, your Medicare Supplement will too. To determine if Medicare covers follow-up treatment, you can follow the same steps as you did to confirm that your surgery was covered. Overall, your Medicare Supplement plan will work seamlessly with your Medicare coverage so that you can focus on healing, rather than bills and paperwork.

Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

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