Does Medicare Cover Back Surgery?

There are various types of back surgeries you can get. Most of the time, it is open surgery and it involves the spine.

But the type of surgery that will be performed on you will depend on your condition or injury. Original Medicare generally provides coverage for surgeries and treatment as long as they are medically necessary.

If you need surgery to repair an injury or other issue with your back, you are probably wondering “does Medicare cover back surgery?” In this article, we answer that question in clear, plain English. It will also cover the average cost of back surgery for those who have to pay for it without insurance coverage.

Does Medicare Cover Back Surgery?

The short answer is yes; Medicare will cover the cost of back surgery. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your back surgery. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for back surgery. Parts A and B provide coverage for many kinds of surgeries, but not all of them. Among those Original Medicare covers include back surgery.

Original Medicare provides coverage for your back surgery if it is considered medically necessary. The operation must also be first ordered by your healthcare provider for Original Medicare to provide coverage.

Coverage for back surgery is provided by Medicare Part A if your back surgery takes place in an inpatient setting. Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days. For days 61 to 90, Medicare Part A will still provide coverage. However, you will pay a copayment each day during that period. After 90 days, Medicare Part A will no longer provide coverage.

However, Medicare Part A provides 60 lifetime reserve days. If you have them, they will still provide coverage for your hospital stay after 90 days, but you will pay for a copayment of around $750 a day.

On the other hand, coverage for back surgery may also fall under Medicare Part B as these surgeries can often take place in an outpatient setting. Once approved, Medicare Part B covers 80 percent of the costs of back surgery. You will pay for the remaining 20 percent.

Part C and Part D Coverage for Back Surgery

Medicare Advantage plans (Medicare Part C) also provide coverage for back surgery. These plans must cover everything Original Medicare covers. But they offer additional benefits as well. The specifics of what extra coverage they provide and how much the costs for this coverage is will vary from plan to plan.

Medicare Part C plans that include prescription drug plans will also provide coverage for medications that your healthcare provider will prescribe to you post-surgery.

Medicare Part D plans provide coverage for medications that you need after back surgery. Part D is a prescription drug plan, and just like Medicare Part C, Medicare Part D plans are provided by private insurance companies.

How Much Does Back Surgery Cost?

The cost of back surgery often lies between $20,000 and $90,000. This price will vary greatly depending on the type of procedure.

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.