Call Our Team today!
1 (855) 600-0137

Getting Surgery While on Medicare

Learning how Medicare covers surgery can be important. The part of Medicare that will cover surgery is dependent on the type.

Medicare Part A vs Medicare Part B

Part A of Medicare covers inpatient hospital care, so if admitted as an inpatient, Part A will cover it, minus the deductible. ($1408 for 2020)

If it is an outpatient procedure, Part B covers those medical expenses incurred once the Part B deductible ($198 for 2020) has been met.

Part B of Medicare covers 80% of outpatient costs. That leaves you responsible for the Part B deductible and the additional 20% of the cost of the surgery. If a Medicare supplement insurance plan is in place, it will help cover these costs.

Medicare Supplement Coverage of Surgery

Surgery is covered as an outpatient benefit by Medicare Part B. A Medicare Supplement Insurance Plan typically covers both inpatient and outpatient procedures in full once deductibles have been met. A good way to remember what a Medicare Supplement Insurance plan will cover is to remember that if Medicare covers a portion of the procedure then the Medicare supplement plan covers the remaining portion.

“The Ignite Team has been a fantastic resource for my wife and me. We couldn't be happier with the assistance they were able to provide us."

- Roger D

"All my expectations were met, which is why I called them first. They are efficient, knowledgeable and made the whole process very easy. You can trust them with all your Medicare needs!"

-Rosemary H.

"If you're looking for an experienced brokerage who know the system inside and out, look no further. You'll be guided to your to perfect solution that is most beneficial to you!"

- Walt G

Medical Necessity is the Key

Medicare is designed to cover expenses that are considered reasonable or “medically necessary.” If receiving cosmetic and some elective surgeries, such as surgery related to routine foot care, then neither Medicare nor your Supplement will pay for it. The Medicare supplement insurance plan won't pay anything toward expenses that Original Medicare does not approve first. Therefore, if a bill is denied by Medicare, the supplement also will not pay. And it won't cover the 20% it would normally pay toward approved surgeries.

Does Medicare Cover Oral Surgery?

Sometimes. Most oral surgeries do not come under the purview of Medicare, except in instances of medical necessity. If, for example, it is for a broken jaw, Medicare will pick up the bill for repairing it.

Oral cancer is another example of a reason why Medicare would pay for oral surgery. If a doctor recommends oral surgery, Medicare may help cover the costs of surgical treatments for cancer. Your doctor will usually be able to confirm what Medicare will or will not cover, so it makes sense to get these questions answered prior to any procedure. Do not be afraid to ask for estimates!

Does Medicare Cover Open-Heart Surgery?

Heart surgery usually requires a hospital stay, so it is covered by Medicare Part A and certainly would be considered “medically necessary.”

Does Medicare Cover Cataract Surgery?

Medicare Part B covers cataract surgery, and it will also pay for a pair of eyeglasses or contacts in full, following the cataract surgery.

Will Medicare Cover ALL Surgery?

Contact a qualified Medicare agent if it looks like there may be a surgery coming up. We can help you determine whether the surgery will be covered under your plan and, if so, which party will be financially responsible.

Generally the answer is yes, most surgeries will be covered between Medicare and a Medicare Supplement insurance plan. It's just a question of medical necessity and using the right part to pay.

Ignite Insurance Group

169 Inverness Dr W #350
Englewood co 80111

855-600-0137

Dental Insurance Plans

Our individual dental plans are affordable and can be used for almost any provider - we are happy to give you a quote for a plan available in your area!