Are you thinking of using Medicare to cover an upcoming surgical procedure? You will need to do a bit of research, in order to ensure that Medicare will help cover your costs. You will also need to consult with the doctor who has recommended your surgery. The federal government’s healthcare program does assist with many surgeries, pre-surgery exams, and even post-surgical aftercare, but it does not cover all surgeries.
Medicare’s official website says that it “covers many medically necessary surgical procedures.” If you’re familiar with Medicare, you’ll know that the term “medically necessary” is the key to unlocking the often complex mystery of what Medicare will cover and what it declines to cover. In general terms, if your doctor has deemed a surgical procedure medically necessary for your continued health and well-being, Medicare will usually cover at least a portion of the costs. But it all depends on your individual situation. Due to the vast number of surgical procedures and the near infinite number of personal variations, though, it is impossible to accurately predict what and how much Medicare will cover in your individual case.
Estimate your surgical costs
Medicare recommends a four-step process to estimate your surgery costs. First, ask your doctor, hospital, or facility how much you’ll need to pay for your surgery and any necessary aftercare. Also, be sure that your doctor, hospital, or facility is authorized by Medicare. If they aren’t, you will be responsible for 100% of the surgical costs. Second, ask them to specify whether you will have inpatient or outpatient care. This affects whether you’re covered under Medicare Part A, Part B, or both. Third, check with any other insurance you may have, including Medicaid or coverage from your employer (or a spouse’s employer), to see if they can offer additional assistance to fill the gaps in Medicare’s coverage. Lastly, log in to MyMedicare.gov and check your Medicare Summary Notice to see if you’ve met your annual deductibles.
Your Part A deductible will need to be paid in full before Medicare will start paying for any expenses incurred during inpatient hospital care. Your Part B deductible will need to be paid in full before Medicare will start paying for any expenses incurred during outpatient care or doctor’s visits. You may also have co-payments after Medicare begins to pay. Consult with your Medicare plan administrator or call Medicare directly at 1-800-633-4227 to find out.
Medicare does not cover cosmetic surgery, most dental and foot care, and many eye-related surgical procedures by default. We have a list of many common surgeries, and you can read up on these specific surgeries for more information. You can also see what procedures Medicare typically covers on the official Medicare website.