How Much Does Medicare Pay For Surgery?

October 5, 2021

Many of us experience anxiety when preparing for surgery. The last thing we want to think about is our financial situation. However, it’s important to prepare for the probability of out-of-pocket costs. Luckily, Medicare is there to help reduce your bill (and stress). Let’s take a look at your possible out-of-pocket costs for surgery and how you can mitigate them.

What Does Medicare Cover? 

Medicare covers many expenses related to essential surgical procedures, but it does not cover elective surgeries (such as cosmetic surgeries) unless they serve a medical purpose. For example, Medicare will cover an eye lift if the droopy lids impact vision, but not if the procedure is purely cosmetic.

Medicare Part A covers expenses related to your hospital stay as an inpatient. The amount you’ll pay out-of-pocket depends on your recovery time. You won’t incur any costs if your inpatient stay lasts between one and 60 days. However, if there are complications and you spend more time in the hospital, you could find yourself liable for coinsurance.

If your hospital stay extends beyond 60 days, days 61 to 90 will cost you $352 per day in coinsurance in 2021. If your hospital stay exceeds 90 days, you’ll pay $704 for every “lifetime reserve” day you spend in hospital. Any additional time in the hospital after you exhaust your “lifetime reserve days” will no longer be covered by Medicare Part A.

While this might sound scary, hospital stays over 3 months aren’t typical. The national average for a hospital stay for Medicare beneficiaries is 5.3 days, according to the Agency for Healthcare Research and Quality.1

Even Americans requiring major surgeries have relatively short stays (the highest average is 8.2 days for respiratory failure). That doesn’t mean people needing surgery don’t stay in the hospital longer than 60 days, but it is very rare.

Medicare Part B covers doctor services, including those related to surgery, certain types of oral surgery, and other outpatient care. Medicare Part B will usually pay 80% of your eligible bills, leaving you to pay the remaining 20%.

If you have Medicare Supplement Insurance (Medigap) or a Medicare Advantage plan, these policies may also help to cover expenses related to your surgery, including the 20% coinsurance that comes with standard Medicare coverage. The benefits of having extra coverage from Medicare Supplement and Medicare Advantage can relieve a lot of uncertainty.

Can I estimate my costs?

It’s difficult to determine exactly how much you’ll spend on your surgery because prices vary depending on your procedure and health care facility. Doctors may also need to perform unexpected procedures if there are complications.

However, you can ask your doctor or a customer care representative at your hospital or healthcare facility what you can expect to pay. Make sure to clarify whether you’ll be an inpatient or outpatient, as this can influence the costs of surgery.

Minimize your out-of-pocket costs

Unless you have a Medicare Supplement, Medicare Advantage, or another ancillary plan, you must pay your yearly deductible for Medicare to cover your surgery expenses. You can confirm whether you’ve already paid by viewing your last Medicare Summary Notice, which you can find online at MyMedicare.gov. Make sure you’ve paid your Part A deductible if you’ll be an inpatient. Paying the Part B deductible is important for doctor’s services and outpatient care.

If you haven’t paid your deductible yet, add this amount to your expected expenses: In 2021, Medicare lists the annual deductible for Part A at $1,484 and for Part B at $203.

You never know what your medical future holds. Be prepared for out-of-pocket expenses by purchasing Medicare Supplement Insurance, a Medicare Advantage plan, or ancillary coverage. SmartMatch™ licensed insurance agents can help you research and compare available options so you can ensure you’re getting all the benefits you deserve. Give us a call at (888) 411-7647 to get started.

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