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Original Medicare provides coverage for any type of surgery as long as there is a given proof that it is medically necessary. Also, it needs to be ordered by your primary care physician or other approved healthcare provider. But sometimes they do not cover certain surgeries if they are not medically necessary.
If you have an issue with you hand that may require surgery, a common question you likely have is “does Medicare cover hand surgery?” In this article, we answer that question in clear, plain English. You will also find the average costs of hand surgery if you have to pay for it yourself.
Does Medicare Cover Hand Surgery?
The short answer is yes; Medicare will cover the cost of hand 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 hand 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 hand surgery. Parts A and B provide coverage for some hand surgeries but not all of them. Among those Original Medicare covers include carpal tunnel surgery.
Original Medicare provides coverage for your hand 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 hand surgery is provided by Medicare Part A if your hand 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, but you will pay a copayment for each day you remain in the hospital. 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 a copayment of around $750 per day.
On the other hand, coverage for hand surgery is often provided by Medicare Part B as it often takes place in an outpatient setting. Once approved, Medicare Part B covers 80 percent of the costs of hand surgery. You will pay for the remaining 20 percent.
Part C and Part D Coverage for Hand Surgery
Medicare Advantage plans (Medicare Part C) also provide coverage for hand surgery. Part C plans have to cover all the same surgeries, treatments, etc. that Original Medicare covers. But each Part C plan will also cover some things that Original Medicare does not. The specifics of what a plan covers and how much the out-of-pocket costs are will vary depending on the plan you have.
Medicare Part C plans that include prescription drug plans will also provide coverage for medications that your healthcare provider will prescribe to you.
Medicare Part D plans provide coverage for medications that you need after hand 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 Hand Surgery Cost?
The cost of hand surgery ranges greatly, from $1,800 to over $25,000 if you have to pay for them out of pocket. This is a wide range, but there are a lot of different types of hand surgeries. They type of hand surgery you need will be the main factor in how much it will cost.
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 Hepatitis C screening?