Medicare covers medically necessary services, robotic surgery is no exception. Since the FDA approves robotics, coverage may be available for some robotic surgery procedures.
In some situations, the use of the newer technology improved patient’s overall outcomes following a surgical procedure. Including cases of robotic cardiac surgery, according to reports by The National Library of Medicine.
Originally, robotic procedures were meant for heart surgery in 1997. Today, surgeons often perform minimally invasive surgeries known as laparoscopic surgery.
Other common robot-assisted surgeries include several procedures. Such as, colectomies made up 15%, hysterectomies at 90% and 20% of prostate removal surgeries are performed robotically.
Medicare Covers Robotic Surgery
Using robotics may increase a surgeons’ precision and visibility, the Mayo Clinic reports. If a healthcare provider determines it’s medically necessary to treat a patient, Medicare may cover for the costs.
Part A pays for the surgery and expenses while inpatient at a hospital or similar setting.
Part B covers outpatient surgery and any relating expenses.
Even if the surgery is robotic, if it’s medically necessary – Medicare should pay for it. Although, both parts may include out-of-pocket expenses like deductibles or copayment and coinsurance costs.
Patients should discuss concerns with their doctors prior to any procedure or surgery. Asking questions about the type of surgery, if it’s robotic or not, and why it’s necessary for treatment.
Any other questions regarding coverage should go through a local Medicare agent. Beneficiaries should understand exactly what their plan pays for to avoid unexpected medical bills.
Does Medicare Cover Robotic Surgery for Prostate Cancer
The Centers for Medicare and Medicaid Services (CMS) doesn’t have a policy for the national coverage on radical prostatectomy. Procedures to remove the prostate may be open, laparoscopic or robot-assisted surgery.
Local coverage is a little different. As it stands, robot surgery for prostate cancer is a service Medicare covers. Additionally, reimbursement for providers is the same as the compensation for traditional (laparoscopic) prostatectomy.
Medicare pays for 80% of the allowable-costs of service for any medically necessary procedure. The beneficiary is responsible for the remaining 20%, unless, additional coverage is in place. Like Medigap Plan F, offering coverage with $0 out-of-pocket costs.
Da Vinci Robotic Hysterectomy Cost and Coverage
Medical procedures like hysterectomies are often a necessary form of treatment, so Medicare benefits pick up the coverage. Patients having a voluntary hysterectomy (non-medically necessary) such as for sterilization, then Medicare won’t cover the costs.
The da Vinci Robotic hysterectomy cost and coverage depend on if the procedure is done at an inpatient or outpatient facility. Part A benefits cover patients who have a hysterectomy at an inpatient hospital setting. Part B pays for outpatient services and hysterectomies.
Both Parts may have deductible amounts that must be met before Medicare will cover costs for any procedure. After the deductible is met, either Part covers 80% of the Medicare-approved expenses. Beneficiaries are responsible for the remaining 20% of the bill.
Da Vinci Robotic Surgery Advantages vs Disadvantages
The da Vinci Surgical System provides options for a minimally invasive procedure rather than having major surgery. New technology advances give more procedure options.
The newer method is becoming more common for certain procedures and surgeries. The da Vinci Robotic System allows surgeons to perform different procedures using only a small incision of about 1-2 centimeters.
Comparable to traditional or open surgery methods, this system has its advantages. Benefits including less pain; with discomfort lasting days rather than weeks like with open surgeries.
The robotic system allows a minimally invasive surgical option for women with fibroids. Qualifying women may have large, numerous, or difficult to access fibroids.
Surgeons use master controls from an operating console. Working the robotic arms as forceps, the surgeon manipulates the controls. This method reduces the chance for complications while lowering the risk of infection because the potential of contamination is much lower.
Hospital stays are shorter. Open surgery may require 3-5 days of inpatient stay while da Vinci Surgery is 1-2 days. Additionally, recovery time is significantly faster. Traditional surgery could leave a patient in recovery for up to 4-6 weeks. However, recovery time is cut down to 1-3 days with this robotic surgery.
Da Vinci Robotic Surgery Disadvantages
Most of the population has shown this method cuts the chance of infection and recovery time almost in half, if not more. Unfortunately, that doesn’t include patients under Medicare coverage.
According to a study, far less Medicare patients had minimal invasive operations than the rest of the population. Researchers believe that imbalance may affect the quality and cost of care.
In turn, older patients have a less positive outcome from surgical procedures. This study examined the medical records of more than 230,000 Medicare beneficiaries. The results found a higher complication rate, more hospital readmission and higher costs of service in patients with Medicare for health insurance.
A professor of surgery at the John Hopkins University School of Medicine in Baltimore made a statement in a recent press release. Dr. Martin Makary said, “This study shows there is an opportunity for Medicare and other payers to spend healthcare dollars more wisely so that they reward high-value care over low-value care.”
How a Medicare Supplement Covers Robotic Surgery
Supplement insurance (Medigap) works with Parts A and B providing comprehensive coverage for out-of-pocket expenses that Medicare doesn’t pay for.
Medigap has 10 standardized plans to choose from in most states. Each plan may provide different coverage benefits, and costs may vary among carriers. However, if Medicare approves the robotic surgery, the Medigap company must approve the robotic surgery.
Medications following a procedure, including pain medications, aren’t part of Original Medicare benefits. Enrolling in a stand-alone Part D prescription drug plan or a Medicare Advantage plan with drug benefits is the best option to get help paying for medications.
If you have questions about coverage or plan options, give your agent a call. Medicare agents can help compare rates or help find a plan that better fits your healthcare needs.
Medicare Advantage Coverage for Robot Surgery Services
While Medicare offers great healthcare benefits to seniors over 65 and to those with disabilities; but it doesn’t cover everything.
Medicare Advantage plans (MA) are alternative insurance policies to Part A and Part B. Many MA plans offer extra benefits for services Medicare doesn’t pay.
Benefits like routine vision, dental and hearing services are part of most MA plans.
Although, cost-sharing, deductibles, copayments, and coinsurance amounts may differ depending on the plan. Variables such as age, service area location, and health conditions (depending on the time of enrollment) may determine what the plan costs.
Our team of Medicare agents can answer any healthcare coverage questions you may still have. Understanding your plan and what options you may have is important.
Give us a call today to get the coverage you need. Let us compare plan rates and see what benefits you may be entitled to. If you can’t call, fill out our online rate form and get the process started.