In general, Medicare covers most medically necessary procedures. So if you’ve been wondering whether Medicare covers surgery, the answer is yes. Which Part of Medicare covers your surgery, though, depends on the type of surgery.
Medicare Part A vs Medicare Part B
If you have a surgery when you have been admitted as an inpatient to a hospital, Medicare Part A may cover the surgery. However, if you have surgery as an outpatient, then your Part B outpatient medical benefits will cover the surgery.
Under Part B, Medicare covers 80% of the cost of your surgery. You are responsible for the Part B deductible and the other 20%. Fortunately, if you have a Medicare supplement, your plan will help to cover your share of the costs.
Medicare Supplement Coverage of Surgery
Your Medicare Supplement covers surgery after Medicare first pays its share. Many people mistakenly believe that surgery is covered under Medicare Part A hospital benefits. However, surgery is covered as an outpatient benefit under Part B even if you stay overnight in the hospital to have the surgery performed.
A good rule of thumb to determine what is covered by your Medicare supplement, is simply to know that if Medicare covers a procedure, then your Medicare supplement covers the portion that would usually be left to paid by you. Surgery is an outpatient benefit under Medicare Part B, so your surgery would be covered like this: Medicare pays 80% and your supplement pays 20%, after you have first met your once-annual Part B deductible.
Medical Necessity is the Key
Remember, Medicare supplements cover surgeries that are reasonable and necessary. If your surgery is for cosmetic reasons or is related to routine foot care, then Medicare nor your supplement will pay anything toward it. Your Medicare supplement, by law, cannot pay for anything that Medicare doesn’t first approve. If Medicare denies your bill, then your supplement will also deny you for the 20% that it might have paid.
Usually no, although there may be circumstances where the medical necessity requires it. For example, if you needed a surgery to repair a broken jaw or fracture to your fast.
Likewise, if you have oral cancer and your Medicare doctor recommends oral surgery, Medicare may help to cover the cost of oral surgery. Always speak with the doctor who is assigning the surgery and confirm that he or she is a Medicare provider. If so, the physician can contact Medicare to request approval ahead of time. Don’t be afraid to ask for an estimate.
Yes. Since this would require a hospital stay, it will likely be covered under Part A.
Yes, Medicare covers cataract surgery under Part B. Part B will also pay for a pair of eyeglasses after your cataract surgery.
Will Medicare Cover YOUR Surgery?
So how can you determine if your benefits will cover your specific procedure? Well, if you work with a full service agency like ours, you can simply call or email the Client Service Team here at Boomer Benefits. We’ll look up your policy and help you determine what coverage level you can expect.
If you do not have an agent because you bought your policy directly from an insurance company, then you would need to call either 1-800-MEDICARE and speak with a Medicare representative, or call the member services line at your insurance company to see if they can give you some direction.
In general, though, yes, Medicare supplements cover surgery. Need help finding a plan with good cancer coverage? Contact us today for assistance.