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Having Medicare coverage is super important as it can provide you with great coverage and help you save thousands of dollars in out-of-pocket medical costs.
But, when it comes to surgeries, what exactly is covered?
In short, Medicare will cover medically necessary procedures. What does “medically necessary” mean? Well, it is services or supplies needed to treat, or even diagnose, a medical issue.
With this in mind, let’s go ahead and discuss what exactly Medicare will cover when it comes to surgeries.
As you may already know, Original Medicare is Part A and Part B combined. Part A will serve as your hospital insurance, whereas Part B will serve as your medical insurance coverage. Part A is also known as inpatient coverage, and Part B is outpatient coverage. So, when discussing surgeries and other serious procedures, determine with your doctor if you will be an inpatient or outpatient, as this can impact what costs you may pay out-of-pocket.
Now, let’s talk about the surgeries you can get coverage for.
For organ transplants, Medicare Part A will cover any services related to kidney, pancreas, lung, liver, heart, and intestine transplants (but only in certain conditions). Part A will also provide coverage for any tests, exams, or labs that need to be performed.
And, in certain cases, it will also cover immunosuppressive prescriptions, follow-up care, and stem cell transplants.
Now, what about Part B? Well, Part B will cover the same services as Part A (kidney, pancreas, lung, liver, heart, and intestine transplants) but only in a Medicare-certified facility. Part B may also cover immunosuppressive prescriptions in certain conditions.
However, unlike Part A, Part B may be able to provide coverage for cornea and bone marrow transplants.
Cosmetic surgeries are typically not covered by Medicare. However, there are certain conditions when it is, such as if you’ve suffered from an injury or need the function of a malformed body part improved. Medicare will also cover breast prostheses if you had a mastectomy due to breast cancer.
There are specific surgeries that Medicare will need approval and authorization for before coverage will even be provided. These surgeries include:
Now, with this in mind, do realize that you will pay completely out-of-pocket for a cosmetic surgery if it is not covered under Medicare.
Other surgeries and related services that could be deemed medically necessary and covered by Medicare can include:
We understand how important it is that you know what type of coverage you are getting with Medicare. That’s why we are here to discuss your coverage options with you and make sure you get the coverage you deserve.
All you have to do is give us a call today, and we can get you started with a free consultation!
We are not connected with or endorsed by the United States government or the federal Medicare program.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.