Does Medicare Cover Hernia Surgery?

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  • Does Medicare cover hernia surgery? Find out what you need to know about your Medicare coverage so that you don't pay more for your procedure than you need to.

Does Medicare cover hernia surgery? If you experience a hernia that cannot be treated without surgery, you can certainly receive coverage. Whether or not you will receive coverage through Medicare Part A or Medicare Part B depends on whether you were operated on in the hospital or if you arranged the surgery at an outpatient facility.  

If you're enrolled in a Medicare Advantage plan, you're covered for everything in your policy that you'd be covered for under traditional Medicare. You will be responsible for a portion of the cost, including your deductible for the year if you've not yet met it. Medicare Part D or your Medicare Advantage may cover the cost of any medications that you're required to take during your recovery.  

What Is the Cost of a Hernia Surgery? 

The cost of your procedure may vary from one facility to the next. Other contributing factors that can impact the price of your surgery include the type of hernia being fixed, the health care provider that you select and the specific procedure required. It's less expensive if you arrange to have the procedure performed in an outpatient facility as opposed to an inpatient setting.  

While your specific experience may vary, the average cost you might pay for an inpatient procedure as your copayment is almost $1,600 plus your deductible. The same procedure would cost you about $900 plus your deductible if you had it performed at a surgical center. 

Where Is the Best Place to Perform a Hernia Surgery?  

The average cost of a hernia surgery performed at an outpatient facility is almost $4,500 and Medicare will cover 80%. It can be as much as 50% more expensive if the procedure is performed at a hospital. If at all possible, it is much more beneficial to have these types of surgeries performed outside of the hospital. You don't need an extended stay for recovery and can usually go home the same day, which means you won’t need to stay at a hospital while you're healing.  

Does Medicare Require Prior Authorization for Surgery? 

This depends solely on the type of plan you're enrolled in. If you're covered by Medicare Part A or B, you won't need preauthorization for your procedure so long as you arrange it through doctors and health care providers that are approved by Medicare. If you're enrolled in a Medicare Advantage plan, you might need to get your procedure approved through your insurance company. Check the details of your plan to see if you need to have it approved beforehand so that you don't have any unneeded billing surprises. 

Will a Medigap Policy Reduce the Cost of a Hernia Surgery? 

While Medicare does cover hernia surgery, you're still required to pay copays and deductibles for most expenses you incur. This copayment can be a substantial amount. A Medicare supplement plan, otherwise known as a Medigap policy, can certainly help you cover those out-of-pocket expenses. Many people enroll for Medigap coverage for the purpose of being able to afford needed procedures without breaking the bank.