As affordable as medicare makes healthcare, it can be pretty difficult calculating the costs shared and the type of medical services actually covered. One wrong miscalculation of a grey area can be down right costly. A common grey area is surgery. Medicare doesn’t actually deny surgery, but it is crucial to make sure you know all of the facts and read the fine print carefully. So, does Medicare cover surgery? Read the article below to find out all of the details.
Does Medicare Cover Surgery?
What Surgical Expenses Does Medicare Cover?
Medicare A, issues 60 days of inpatient care. Now as scary as this seems, most people don’t stay this long in the hospital. In fact, its pretty rare to exceed the first 60 days; the average hospital stay is 4.9 days – 15 times less than the grace period allotted. Even major surgeries like heart transplants don’t need up to 60 days inpatient care.
Medicare B, involves coinsurance for surgeries that involve outpatient care – like dental surgeries where you keep going home and coming back to the dentist for further treatment. In this case, Medicare can cover up to 80% of your costs.
If you’re a Medicare beneficiary, they will most likely cover the surgery costs incurred that serve a medical purpose. Meaning essential not elective procedures. For example, Medicare will cover a plastic surgery that involves fatal burns, but not cosmetic plastic surgery if the burn is minor and non essential.
Your expenses as a patient, while recovering from surgery, will also be covered for up to the first 60 days. By the 61st day, you’d have to start bearing the cost. If for some reason you develop a complication either during surgery or recovery that elongates your stay as a patient, you are still required to contribute to the expenses after the 60 days. The actual amount you have to pay alongside Medicare after the exceeding the 60 days, varies. As of 2018, inpatient care between Day 61 and Day 90, will cost you $335 per day. Thus, if you spend all 90 days in the hospital, you’d be paying $10,050 for the extra days. If your hospital stay exceeds 90 days, then you get coinsurance daily payments of up to $658; this is only valid for the number of lifetime reserve days you have. Once those days end, Medicare will cease all forms of insurance coverage. Meaning you’ll be solely responsible for all bills.
Is It Possible To Calculate Medicare Cost Share?
The short answer is NO. Reason being is that hospitals charge differently for surgeries. If Medicare decides to pay 80% of your costs, you could still end up with a huge bill if the hospital charges exorbitant prices.
Besides, what happens if there’s an unexpected complication? The best you can do is ask your health care provider what they charge, and make a guess from there. Just keep in mind that there are still a possibilities of unforeseen circumstances to arise. Also make sure to remember that outpatient care always costs less, and Medicare usually covers more of the costs for outpatient care.
So does Medicare cover surgery? Sure, if medically necessary, but only for limited time periods. But there are ways to minimize your cost sharing responsibility so read and understand the fine print carefully.