Does Medicare Cover Back Surgery?

In this article...
  • Find out if Medicare covers back surgery and learn what other options might be available to help you pay for out-of-pocket expenses related to your treatment.

Back surgeries are expensive. According to a study published by Statista, the average spinal fusion surgery cost $110,000, as of 2019. It goes without saying that most Americans are unable to foot the bill upfront themselves. Find out below if Medicare covers back surgery and how much coverage you might be eligible for. 

Does Medicare Cover Back Surgery?

If your doctor deems that back surgery is medically necessary due to an injury or illness, Medicare will typically help cover the expense. 

Back surgery is normally covered under Medicare Part A or Part B. These components of Medicare provide funding for hospital stays, skilled nursing and procedures that are performed by qualified medical practitioners, as well as follow-up visits with your surgeon or primary care physician. In most cases, that means surgery must be prescribed by a medical doctor — a chiropractor is generally not authorized to determine whether your surgery is required.

Types of Back Surgeries Covered By Medicare

 

  • Laser spine surgery: Laser spine surgery may be covered by Medicare when it's determined to be medically necessary by your doctor.
  • Disc replacement surgery: Disc replacement is typically only covered by Medicare when it's for a beneficiary who is 60 years of age or older. This type of surgery must be approved by a Medicare Administrative Contractor before it can be covered.
  • Spinal fusion surgery: This is the most common type of back surgery and is typically covered by Medicare when it's deemed medically necessary. 

Out-of-Pocket Expenses

As with any Medicare claim, you might be required to pay a portion of your cost out of your own pocket. While many components of your care are generally covered by Medicare Part A and Part B, most plans have deductibles, copayments or coinsurance that you need to cover yourself. Additionally, if you need prescription medications to manage pain or prevent infection, you may have to pay for these unless you have Medicare Part D benefits for prescription drugs. 

What Are Some Ways to Pay for Back Surgery?

While Medicare Part A and Part B can provide assistance with back surgery costs, you might be able to access additional benefits if you're also enrolled in Medicaid or Medicare Advantage.

Does Medicaid Pay for Back Surgery?

Some Medicare beneficiaries are dually eligible for Medicare and Medicaid. When this happens, you can take advantage of benefits from both plans. While Medicaid generally covers the same portion of costs that your Medicaid plan does, you might be able to combine your benefits to reduce out-of-pocket expenses. 

Using Medicare Advantage Benefits

Medicare Advantage Plans are provided by private insurance companies, and they often provide you with extra coverage that's not included with Medicare Part A and Part B. Depending on your coverage, you may be eligible for assistance with some of your out-of-pocket expenses, including your deductible or coinsurance payments. To determine what you're covered for, it's best to contact your Medicare Advantage Plan provider. 

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