Does Medicare cover back surgery?
Medicare covers back surgery as long as it is medically necessary and meets the guidelines for treatment of your condition. Back surgery coverage with Medicare includes both Part A and Part B to cover doctor fees and hospital costs. Your out-of-pocket costs with Original Medicare for back surgery will include deductibles and a 20% coinsurance for Part B. Medicare Supplement can help cover those out of pocket costs.
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UPDATED: Jan 20, 2021
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- Medicare covers back surgery as long as it is medically necessary
- Both Part A and Part B coverage will be involved in covering doctor and hospital costs
- You will be responsible for deductibles and coinsurance amounts unless you have supplemental coverage
Does Medicare cover back surgery? Yes, Medicare covers back surgery that is medically necessary, with coverage from both Part A (hospital) and Part B (medical) covering different aspects of the procedure. Out-of-pocket expenses include the deductible for both Parts A and B as well as a 20 percent coinsurance amount for Part B. With a Medicare Supplement plan, these expenses could be covered.
If you have a Medicare Advantage plan for your health insurance, your coverage may be different. You may have no deductible, and your coinsurance amounts may be different. Check with your Medicare Advantage plan provider to find out what your coverage looks like.
If you’d like to shop for a Medicare plan to cover back surgery out-of-pocket costs, enter your ZIP code now to get started.
What is the back surgery coverage with Medicare?
If you have original Medicare, back surgery is covered under both Medicare Part A and Part B. Part A covers the hospital portion of the charges, including inpatient care, general nursing, and drugs administered during your stay. Part B covers the medical side of your treatment, such as doctor’s fees and tests to diagnose the back problem.
If you have Medicare Advantage, Parts A and B are combined in one plan administered by a private insurance company. Your Advantage plan will pay for the surgery in the same way, but may have different deductibles and coinsurance amounts.
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What kinds of back surgery does Medicare cover?
Most back surgery will be covered as long as it is medically necessary and the type of surgery meets Medicare’s guidelines for treating the diagnosis. Some types of back surgery covered by Medicare include:
- Laminectomy to treat spinal stenosis
- Foraminotomy to treat a herniated disk or degenerative disk disease
- Vertebroplasty and Kyphoplasty to repair fractures of the spine caused by osteoporosis
- Discectomy to remove a herniated disk
- Fusion of two bones with grafts or metal screws.
- Artificial disk replacement to treat a damaged disk
Does Medicare cover laser back surgery? Yes, again as long as it’s medically necessary. Your doctor will confirm with Medicare that the type of surgery being recommended is covered. Prior authorization isn’t required for most inpatient treatment.
What is the cost of back surgery with Medicare?
Your out-of-pocket costs with Medicare for back surgery will include paying your Part A and Part B deductibles for the portions of the treatment that fall under each of those categories.
You may also have to pay a health care coinsurance of 20%. for Part B coverage According to Medicare.gov, that amount can vary depending on the type of surgery you are having. Discuss the costs with your provider before you have the surgery so you will know what to expect.
If you have Medicare Advantage, your out-of-pocket cost will depend on the plan you have selected.
Does Medicare cover back surgery? The Bottom Line
As long as your back surgery is medically necessary and meets Medicare’s guidelines for treating your particular problem, your back surgery will be covered by Medicare. You may have some out-of-pocket costs depending on whether you have Original Medicare or Medicare Advantage, and whether you have a Medicare Supplement policy.
To look for extra Medicare coverage for back surgery, including Medigap plans, enter your ZIP code now.