Appendicitis affects over 200,000 people a year in the US. There are a few main causes for this common condition.
Viral or bacterial infections are two of the main reasons. The blockage of the appendix by stool, a tumor, a foreign body or roundworm/threadworm is another common cause. Genetics can also play a role.
The most common way to treat appendicitis is through appendix surgery. This surgery is known as an appendectomy.
Undergoing appendix surgery can be quite expensive and not everyone who needs it can afford it.
So a common question many people have is, “does Medicare cover Appendix Surgery?” In this article, we answer that question in clear, plain English. You will also find the average costs of appendix surgery, as well as other helpful info.
Does Medicare Cover Appendix Surgery?
The short answer is yes; Medicare will cover the cost of appendix surgery. Though, as is often the case with Medicare, certain conditions have to be met for Medicare to pay for your appendix surgery. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for appendix surgery. Appendicitis is a medical emergency. That means you can almost always expect that Medicare to provide coverage for it because it’s always a medically necessary procedure.
Medicare Part A will provide coverage for undergoing appendix surgery in an inpatient setting. If your inpatient stay for appendix surgery lasts longer than 60 days, Medicare Part A will charge you for a co-payment.
On the other hand, if you undergo appendix surgery in an outpatient setting, Medicare Part B will provide coverage for your expenses. Medicare Part B will also provide coverage for emergency room costs and ambulance service expenses for your emergency appendix surgery.
Medicare Part B will cover 80 percent of the costs of your appendix surgery. You will pay for the remaining 20 percent.
Part C Coverage for Appendix Surgery
Medicare Advantage plans (Medicare Part C) also provide coverage for appendix surgery. They cover everything Original Medicare covers, as well as offer some extra benefits. However, exactly what they cover and how much the out-of-pocket costs are will vary depending on the specifics of your plan.
Most Medicare Part C plans allow you to use an out-of-network hospital for your appendix surgery (or any emergency for that matter).
Medicare Part D will also provide coverage for certain medications you may need after you undergo appendix surgery. Some of these medications include antibiotics and pain medications.
How Much Does Appendix Surgery Cost?
The costs of appendix surgery ranges from around $10,000 to $35,000. Sometimes they can be even more than that.
However, if the surgery is an uncomplicated open appendectomy, it may cost less than $10,000.
One of the things that affects the overall costs of your appendix surgery is whether the operation is open or laparoscopic. Most of the time, open appendix surgeries are much cheaper than laparoscopic appendix surgeries.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover assisted living?