How Does Medicare Cover Surgical Procedures?

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( — February 19, 2019) — How does Medicare cover surgical procedures? Can it cover all of the expenses? Surgery can affect your budget, especially when you do not have enough funds to support the procedure in the first place. That’s why Medicare can help you to reduce your surgery bill. This article will go over how Medicare covers surgical procedures and what to expect in terms of coverage if you need surgical work done.

What Does Medicare Cover?

Medicare will cover most of your expenses related to surgical procedures. However, it will not cover cosmetic surgeries unless they have a medical reason behind them. For example, it can support an eyelid surgery if the condition is affecting your vision. It can also support nose surgery if it affects your breathing. In brief, it can cover your surgeries with a medical purpose.

Medicare Part A will cover the expenses of your hospital stay. The recovery time will determine the amount that needs to be covered. You will not need any coinsurance if the recovery time does not exceed more than sixty days. If any complication arises and you need to spend more than sixty days in the hospital, then you will need coinsurance to support the additional stay.

How Does Medicare Cover Surgical Procedures?

Spending Above Sixty Days

If you extend your stay from sixty-one days to ninety days, it will cost you approximately $335 per day in coinsurance, depending on what company and coverage you opt for. If it extends more than ninety days, you will have to spend about $658 per every lifetime reserve day.  If you need to stay more than lifetime reserve days, then Medicare Part A will not support your expenses. However, you might not face such a situation.

For major surgeries like open heart procedures and liver transplants, you need to stay for about seven days in America; but that does not mean that people do not stay more than sixty days in the hospital.

Services Covered by Part B

Medicare Part B will cover doctor services related to your surgery that includes some kind of oral surgery and other outpatient care. Medicare Part B will pay eighty percent of the eligible bills and you will have to pay the remaining twenty percent.

If you have Medigap (Medicare Supplement Insurance), it can cover some surgery expenses as well. It might cover Part A coinsurance and Part B coinsurance. Many of them cover a part or all of Part A and Part B deductibles.

How to Estimate the Cost

It is not possible to estimate the exact cost as the price might vary significantly depending on the type of the procedure and the medical facility where you are planning for surgery. The price will increase in the case of unexpected complications. Though it is not possible to get the exact cost, still, you can inquire your doctor or customer care to get an estimation of the overall expenditure. Also, do not forget to ask, you will be an outpatient or inpatient. It will affect the cost and coverage.

Bottom Line

So, how does Medicare cover surgical procedures? It will cover most of the medical surgeries excluding cosmetic surgeries without any medical reason. You can also purchase additional supplemental insurance programs to cover any additional costs.