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Will Medicare Cover My Upcoming Surgery


If you’re on Medicare and need surgery, you might be wondering about coverage. Well, we’re here with your guide to Medicare coverage for your surgery. First, if your surgery is inpatient, Part A benefits apply. But, if your surgery is outpatient, Part B benefits apply.

Now, let’s go over some more specific details on surgery coverage.

Does Medicare Cover Surgical Procedures

If surgery is medically necessary, you’ll have coverage. Many surgeries are elective, while some require prior authorization. Medicare Part A and Part B pay for 80% of the bill. To avoid paying the 20%, you can buy Medigap.

Below, we’ll explain which procedures get coverage and which you’ll have to pay yourself.

Does Medicare Cover Heart Surgery?

Heart surgery, including open-heart surgery, receives coverage when medically necessary. Coverage is for those with cardiovascular disease as well as those with other heart conditions. Part B covers outpatient heart procedures, such as angioplasties and stents.

Also, with new technology, robotic cardiac surgery is on the rise. When FDA-approved and medically necessary, robotic surgery will have coverage.

Does Medicare Cover Joint Replacement Surgery?

Joint replacement surgeries such as knee replacements and hip replacements can be costly. If medically necessary, you’ve got coverage. A Medigap policy can help you save on the cost.

Does Medicare Cover Plastic Surgery?

If you’re getting cosmetic surgery to make changes to your looks, you’ll pay for the procedure yourself. But, Medicare covers a portion of costs for plastic surgery if it’s necessary. Examples of this are reconstruction surgery after an accident or severe burns.

Or, blepharoplasty if drooping skin blocks your eyes and your vision suffers. Also, to keep your costs lower, we suggest making sure your doctor accepts Medicare assignment. There are several other examples of coverage for plastic surgery that will be approved due to medical necessity. In some cases, your doctor needs to write a letter to explain the procedure’s medical necessity.

Does Medicare Cover Weight Loss Surgery?

Many American adults struggle with obesity and the health complications it causes. Weight loss surgery, such as bariatric surgery, can be the answer for the morbidly obese. Luckily, certain FDA-approved weight-loss surgeries have coverage. However, the surgeries get approval or denial on a case-by-case basis.

Does Medicare Cover Anesthesia?

Part B covers most anesthesia. But, only sometimes is dental anesthesia covered, such as when the patient has jaw cancer or a broken jaw. Parts A and B don’t cover most dental costs, so, a dental plan can help you.

Does Medicare Cover Other Surgeries?

From carpal tunnel surgery to gender reassignment surgery, coverage is available when the procedure is medically necessary. A supplemental plan can help you pay for your surgery.

Does Part A cover outpatient surgery?

Usually, Part A doesn’t cover outpatient surgery. Part A is inpatient, hospital insurance. Since it’s an outpatient service, Part B will cover this type of surgery if medically necessary.

Will my Medigap cover my surgery?

Medicare Supplements cover the same services covered by Part A and Part B. A Medigap plan pays for the remaining 20% that Medicare doesn’t cover. In other words, if Medicare covers the surgery, then your Medigap plan will pick up the remaining cost.

FAQs

Does Medicare cover same-day surgery?
Part B covers same-day, necessary outpatient surgery.
Does Medicare require a preauthorization for surgery?
For some elective surgeries, Medicare requires prior authorization.
Will Medicare pay for my pre-operative visit?
If the purpose of the visit and surgery is medically necessary, Medicare will pay. Contact your surgeon before making an appointment.
Does Medicare pay for rotator cuff surgery?
Yes, Part B will cover the procedure if medically necessary. Part A can cover additional skilled nursing facility services you might need after your surgery on your shoulder.
Does Medicare cover back surgery?
If your back surgery is medically necessary, you’ll receive coverage.
Does Medicare cover sinus surgery?
If necessary, Medicare will cover your sinus surgery.

How to Get Extra Medicare Coverage for Your Surgery

If you’d like 20% extra coverage in the form of a Medigap plan, give us a call at the number above. We have agents in every state, waiting to help. Also, we can help you compare plan options in your area. We’re committed to finding the best plan for your needs and budget.

Another option is to fill out our online rates form to see your rates now.

Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

4 thoughts on “Will Medicare Cover My Upcoming Surgery

  1. What type of plan can l buy if l have Medicare Advantage plan to pay the costs that Medicare A and B don’t cover?

    1. Hi Lillian! You would have to disenroll from your Medicare Advantage plan and enroll in a Medigap plan instead since you cannot have both, but either or. To get almost everything covered with the exception of the Part B deductible, you would want to enroll in Plan G.

    1. Hi Leslie! This is something you would need to contact Medicare directly about to determine coverage. However, if the doctor deems it medically necessary I would think that yes, they would cover it. Coverage would fall under Part B.

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