Do you need surgical coverage? Get professional information and advice on estimating costs, types of surgery and procedures covered. Once you reach your Part B deductible, you pay 20% of the amount approved by Medicare for the services of a doctor or other health care provider. You usually also pay a co-pay for each service you receive at an outpatient hospital. There are exceptions for expensive surgical procedures (called “comprehensive services”), such as total knee replacement surgeries.
For these services, you pay 20% for the entire care episode, including medications, lab tests, and other services. In most cases, the copay can't exceed the Part A hospitalization deductible for each service you receive. Medicare Part A covers inpatient surgeries once you reach your deductible. You may owe coinsurance beyond the Part A deductible for extended hospital stays or benefits in nursing facilities.
Does Medicare cover surgery? Yes, as long as surgery is medically necessary to treat an injury, illness or medical condition. Part A covers inpatient surgeries and hospital stays, and Part B covers outpatient surgeries, as well as some aftercare and EMD. However, you may still be responsible for some out-of-pocket expenses, such as coinsurance and annual deductibles before you share the costs. Medicare doesn't cover elective surgeries.
Original Medicare generally doesn't cover the cost of a nursing home, assisted living facility, or long-term care facility. Medicare Part A does cover care provided in a skilled nursing facility with certain conditions and time limitations. For example, Medicare doesn't cover breast augmentation for cosmetic reasons, but it does cover reconstructive surgery after a mastectomy. Medicare Part B (also known as health insurance) provides coverage for preventive and medically necessary care services. Medicare Part B (health insurance) helps cover the cost of medically necessary durable medical equipment if a doctor prescribes it for use in the home.
In general, Medicare Part A (also known as hospital insurance) can cover inpatient hospital care, care in nursing homes, care in nursing homes, palliative care, and home health care.
