Wondering if your Medicare plan will cover your upcoming surgery? The short answer to this question is “yes.” But there is generally more to it than that. It all comes down to the type of procedure and the parts of Medicare that cover them.
CORE Insurance is ready to help you figure out the best way for you to get your next surgery covered by Medicare. Maybe you already have the best plan or maybe it’s time for a change. We want you to get the best care possible, and the first step is determining how your surgery might be covered by Medicare.
How Medicare Covers Surgeries
Medicare does, in many cases, cover the costs of medically necessary surgical procedures. Yet, it varies how it is covered. Depending on your needs, your surgery may be covered under Medicare Part A or Part B. Under certain circumstances, you may need to also consider a Medicare Supplement plan or Medigap plan. Let’s look at an overview of plan options.
Medicare Part A, Part B, and Supplement Coverage
The type of Medicare that will cover your surgery depends on the type of surgery you need. For example, an inpatient hospital procedure may be covered under Medicare Part A, while outpatient procedures will be covered by Part B benefits.
However, the outpatient benefits of Part B will only cover 80% of your procedure; you will still be responsible for the other 20%, plus your deductible. In this instance, a Medicare Supplement plan can help. Your Medicare Supplement plan can cover the rest of your costs after Medicare has covered its share – but only after you have met your Part B deductible.
Medical Necessity
The key phrase in all of this is “medical necessity.” As long as your procedure is Medicare-approved, both Medicare and Medicare Supplement may cover the costs. Medicare, for example, will not cover cosmetic surgery, as it does not relate to diagnosing or treating an illness or injury.
It is worth noting, too, that some medically necessary oral surgery, like repairing a broken jaw or treating oral cancer, may be covered by Medicare, but other kinds are generally not covered. It is best to check with your doctor beforehand.
Doctor Participation
For any procedure to be covered by Medicare, your doctor must first accept Medicare. This allows your surgery to be covered and ensures you will not have any extra charges. If you don’t see a doctor that accepts Medicare, the extra charges can still be covered under a Medigap plan. If you are set on keeping a doctor that does not accept Medicare, a Medigap plan may be an option for you.
Find the Plan that Fits Your Needs
There are a lot of options when it comes to Medicare and several ways your surgery may be covered. It can be difficult to determine what your best course of action should be. For example, maybe switching to a lower maximum out of pocket plan is best for you, if your surgery is very expensive. You may also have to consider how many days you might need to recover and how your plan fits with your in-hospital needs.
Whether you’re looking to make a change to your Medicare plan or if you have questions about whether your next surgery is covered, we can help. CORE Insurance is here to make sure you’re getting the most out of your Medicare plan. We can help you find the plan that works best for you and helps cover the costs of your surgeries.
Schedule a free consultation to see if your plan meets your needs for surgery.
