Medicare is a government health insurance program that helps people 65 and older, as well as those with disabilities, pay for some of their medical costs. There are different parts of Medicare, and each one covers different services. In this blog post, we will discuss the costs of outpatient surgery with Medicare. We will also discuss what to expect as far as surgery through Medicare. Stay tuned!
What is Outpatient Surgery?
Outpatient surgery is any type of surgery that does not require an overnight stay in the hospital. This means that you can go home the same day as the surgery. There are many different types of outpatient surgeries. For Instance:
- outpatient facilities
- ambulatory surgical
- hospitals
Does Medicare Part A Cover Outpatient Surgery?
Medicare Part A is hospital insurance, and it covers inpatient care, which includes surgeries that require an overnight stay. Part A generally does not cover surgery.
Does Medicare Part B Cover Outpatient Surgery?
Medicare Part B is medical insurance, and it covers outpatient care, including surgeries. Part B has a deductible, which is the amount you have to pay before your insurance starts paying. After you meet your deductible, you will still have to pay 20% of the cost of your surgery. There are also some services that Part B does not cover, such as cosmetic surgery.
What Else Should You Know About Medicare and Outpatient Surgery?
How much you pay might also be affected by other factors, such as:
- If you have outpatient surgery in a hospital, they generally will pay its portion of the non-physician hospital services, and you will be responsible for paying the Medicare deductible or copayment.
- If Medicare considers the outpatient surgery a preventive service, Part B might cover the service at 100% of the Medicare-approved amount.
- If you have a Medicare Supplement (Medigap) plan, it may help pay your out-of-pocket costs for outpatient surgery. Different Supplement plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. You may contact the plan’s customer service for benefits information that is specific to your outpatient surgery.
- If you are enrolled in a Medicare Advantage plan, the plan is required to offer at least the same coverage as Medicare Part A and Part B provide. However, Advantage plans may have different deductibles, coinsurance, and copayment amounts than Part A and Part B. Consult your Medicare Advantage plan’s customer service for details of how it covers your outpatient surgery.
- Remember, you may want to use doctors, hospitals, and outpatient surgery centers that accept Medicare assignments. Otherwise, you might pay in full regardless of whether or not the outpatient surgery is medically necessary.
How Long Does The Approval Process Take With Medicare for Outpatient Surgery?
The length of the approval process will vary depending on the type of outpatient surgery you need. For example, if you need cataract surgery, Medicare will likely approve the surgery within a few days. However, if you need more complex surgery, such as heart surgery, it may take longer to get approval.
What Does Medicare Advantage Cover With Outpatient Surgery?
Medicare Advantage plans are required to cover at least the same services as Part A and Part B. However, they may have different deductibles, coinsurance, and copayment amounts. You will need to check with your specific plan for details on how it covers outpatient surgery.
Would a Medicare Supplement Give me 100% Coverage on Outpatient Surgery?
No, Medicare Supplement plans do not cover 100% of the costs of outpatient surgery. They are designed to help pay for some of the out-of-pocket costs that Part A and Part B do not cover. These include deductibles, coinsurance, and copayments. You will need to check with your specific plan for details on how it covers outpatient surgery.
Depending on what secondary coverage you select you could limit your out-of-pocket costs substantially. Knowing what plans to put in place is the key. Most Supplement plans cover the 20% so that would limit your cost to just the $233.00 Deductible. The majority of advantage products would charge a flat copay for the surgery. Either way, if you go with secondary products you can dodge a large financial bullet. If you are worried about costs with outpatient surgery, give us a call. We are here to help.