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How Much Medicare Covers for Surgery

How Much Medicare Covers for Surgery

For many of us, the days before and after surgery are a time of mixed feelings. There is anxiety, excitement, plenty of questions, and a few doubts. The most common question is always, “What will Medicare cover?” You need to know that as long as you have the basic coverage that Medicare provides for your area, they can cover up to 100% of the costs for what’s considered “routine procedures” related to your diagnosis.

How Much Medicare Covers for Surgery

To be considered an outpatient, the surgery must be performed without any hospital stay for the patient. The type of surgery covered by Medicare is called a “routine procedure.” These include lumbar punctures (spinal taps), tonsillectomies and adenoidectomies, cataract removals, procedures for hernias and inguinal hernias, and biopsies of skin lesions. Anything you can do in a doctor’s office or operating room would be considered a routine procedure, including reconstructive surgery from burn injuries. The amount that Medicare will pay varies between the states, but it could reach up to $30,000 per year.

One must be aware that Medicare will not pay for cosmetic surgery, nor will it cover any experimental or research-related procedure. Also, any Medicare patients who receive treatments from a doctor not listed as a provider in their plan are not entitled to benefits. Finally, End Stage Renal Disease (ESRD) patients will only be eligible if they’ve undergone a kidney transplant.

Surgeries Covered By Medicare

The surgery may be performed in a hospital, outpatient center, or office. Still, it must be performed by a doctor who has reviewed your case beforehand and recommended that you undergo the procedure. To know more about Medicare and coverage read this post.

Some of the more common outpatient surgeries include:

1)Plastic Surgery

2)Hernia Repair

3)Breast Cancer Surgery (Mastectomy)

4)Removal of Adenoids/Tonsils

These are just a few examples of what Medicare considers routine surgery. You may call Medicare to see if your procedure is covered.

What Medicare Will Not Cover

Plastic surgery that is not deemed “medically necessary” by a doctor will not be covered. Also, cosmetic surgeries that are deemed to be purely for medical purposes, as well as any invasive cosmetic procedures, will not be covered by Medicare.

In addition, Medicare will not pay for any hospital stay associated with the surgery. This includes recovery time, pain and illness, medications, and costs related to any additional surgeries or procedures.

Medicare will not cover the following:

1)Botox injections

2)Bulk reduction (breast reduction) of female breasts

How To Get Started

You can find out whether or not Medicare will cover your procedure by contacting your local Social Security office. You will need proof of age, a diagnosis, and confirmation that you are healthy enough to undergo the procedure. You will also need confirmation from your doctor that the surgery is necessary and routine. If these criteria have been met, Medicare could cover up to 100% of the costs of some procedures. Don’t forget to ask about any paperwork you may need to fill out, how long you will need a doctor’s note, and how much co-pays are for any additional procedures or follow-ups with the surgeon. Medicare is an excellent program for those who are unable to afford the medical care of others. If you are approved for Medicaid, you may be able to receive Medicare benefits as well. However, if you have private insurance, such as a private or public plan through your employer, Medicare will not offer to pay any of your medical expenses.


Medicare is a very useful benefit for those who are unable to afford the medical care of others. In fact, you may receive this benefit without having to pay for it out of your own pocket if you have Medicaid or private insurance through an employer.

Once you see that Medicare will cover your surgery, the benefits are unlimited. You may take the time to confirm with them before getting a second opinion from another healthcare provider. You probably won’t need one if everything checks out, however, there may be instances in which additional testing or follow-up procedures might be needed, and Medicare will reimburse at least 80% of these costs.

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