ORIGINAL MEDICARE
Medicare covers most procedures that require anesthetics, providing they’re medically necessary. Americans age 65 and older or those with disabilities may wonder how does Medicare cover anesthesia services?
Well, if the patient’s healthcare provider deems it medically necessary, Medicare should cover the costs of service; including anesthesia. However, the exact cost may differ depending on the patient’s plan, coverage options, and several other factors.
Does Medicare Cover Anesthesia
Medicare covers medically necessary anesthesia
Medical procedures are often paired with anesthetics in both inpatient and outpatient hospitals and surgical centers. Original Medicare, Parts A, and B may cover these services for qualifying beneficiaries.
Qualifications include a medically necessary reason from the beneficiary’s healthcare provider. Additionally, the procedure must be by a healthcare provider accepting Medicare assignment.
Using a provider outside of the assignment may result in extensive out-of-pocket costs. Unfortunately, this could mean, the beneficiary assumes responsibility for the difference of what the doctor charges and what Medicare is willing to pay.
Elective surgeries such as cosmetic procedures are not included in coverage unless for a medical reason. Medicare may cover anesthesia for an eye lift if the patient’s eyelid is impairing their vision.
Medicare Surgery Coverage
When a patient undergoes surgery or procedure, anesthesia is typically necessary. While the exact costs may be hard to determine because it’s difficult to know what services a person will need.
However, beneficiaries may estimate a total cost amount. Patients should ask their healthcare provider, hospital or providing facility about out-of-pocket expenses for the surgery and any aftercare, if necessary.
The costs may vary whether at an inpatient or outpatient facility. Patients can better estimate the total cost by knowing what type of facility the service will be administered. Outpatients may be able to choose between ambulatory surgical centers and hospital outpatient facilities.
Review the Part A deductible for hospital admissions or Part B deductibles for doctor’s visits and outpatient care. Many beneficiaries must pay the deductible amounts before Medicare coverage starts. Once coverage starts, there may still be copayments for services.
Beneficiaries can look at the most recent Medicare Summary Notice (MSN) to check if deductibles have been met. The MSN is usually sent via the United States Postal Service, otherwise, the information is available online at MyMedicare.gov.
The next step is to talk to any other insurance providers. Other insurances may include Medigap policies, Medicaid plans, and/or a spouse (or self) employer coverage. Sometimes, other insurances (secondary insurance) may cover the costs Medicare doesn’t.
Anesthesia
The National Institute of Health (NIH) defines anesthesia as “a medical treatment designed to eliminate pain during a surgical procedure.” Anesthesia comes in two forms, the first is a general anesthetic; which affects the entire body. Whereas local/regional anesthesia focuses on targeting a specific area of the body.
Anesthetic drugs are given by anesthesiologists through either an IV or by inhaling the gas through a mask. Both local and regional anesthesia is typically given by injection while the patient remains awake throughout the procedure.
Medicare Coverage for Anesthesia for Colonoscopy
Michelle Andrews from National Public Radio states that “if a polyp is found during the test” coverage for a colonoscopy screening is once every 2 years for high-risk colorectal cancer patients.
For that not high-risk coverage is once every 10 years under Parts A and B. Although, Medicare may cover once every 4 years if the patient has a previous flexible sigmoidoscopy.
For these patients, Medicare may waive the deductible and coinsurance when paying for anesthesia services for screening colonoscopies (non-diagnostic). However, if the colonoscopy screening becomes a diagnostic colonoscopy Medicare may only waive the deductible amount when paying for services.
High-risk factors for colorectal cancer include:
- Personal history of inflammatory bowel disease
- A sibling, parent, or child who’s had colorectal cancer or an adenomatous polyp
- Personal history of Crohn’s Disease and/or ulcerative colitis
- Family history of adenomatous polyposis
- Personal history of colorectal cancer
- Family history of hereditary nonpolyposis colorectal cancer
- Personal history of adenomatous polyps
Medicare Advantage Coverage for Anesthesia
Medicare Advantage Plans or Part C plans are alternative coverage options to Original Medicare. However, MA plan coverage must include (at least) the same benefits as Parts A and B. Although, most MA plans include additional benefits that Medicare doesn’t cover.
Benefits such as routine dental, vision and hearing services. Hospice care still falls under Part A coverage, even if the beneficiary enrolls in an Advantage plan.
Let’s look at Joan’s situation for example.
Joan went to visit her dentist to get her wisdom teeth extracted. Prior to the procedure, the office anesthesiologist gave Joan a local anesthetic. The injection in the gums was to prevent pain while the dentist works.
Joan has a Medicare Advantage plan that includes dental services. Therefore, Medicare will likely cover the cost of anesthesia for this service. Although, if Joan had Parts A and B for coverage, Medicare would not cover the costs. Reason being, Original Medicare doesn’t over coverage for dental services.
Medigap and Anesthesia Coverage
Medicare Supplements are otherwise known as Medigap plans. These plans offer additional coverage for out-of-pocket expenses that Medicare doesn’t cover. Supplement insurance covers things like copayments, coinsurances, and deductible costs.
Although, benefits and cost of coverage may vary among plans. There are many different Medigap plans to choose from. Private insurance companies working with Medicare provide ten standard Supplement insurance plans. Each plan is identifiable by letters ranging from A-N.
Coverage may vary depending on the service area, not all areas offer all Medigap plans. Likewise, the costs of copayments, coinsurance and deductibles may be different. Contact your local Medicare agent to discuss your costs of anesthesia with Medigap coverage.
We understand the concern for the cost of your surgical procedures. If you’re wondering what your plan covers relating an upcoming surgery or procedure, give us a call today! One of our licensed Medicare agents will happily answer any questions about coverage.
We can compare different rates and determine if a different plan is best for your budget. Don’t have time to call today? We understand you can fill out an online form instead and get the process going.
