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A hernia is a condition wherein an internal organ, such as the intestine, bulges through the muscle and skin. A common cause of hernias is when a person strains weak muscles by something like heavy lifting. Usually, hernias do not bring pain and are harmless. However, in some cases, they can cause discomfort and pain. One of the ways to treat hernias is through hernia surgery.
If this is something you may need, a common question many have is, “does Medicare cover hernia repair?” In this article, we answer that question for you in clear, plain English.
Does Medicare Cover Hernia Repair?
The short answer is yes. Medicare will cover the cost of hernia 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 hernia 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 hernia surgery. Parts A and B provide coverage for hernia surgery if it is considered medically necessary by your healthcare provider. Original Medicare provides coverage for the two types of hernia surgery which are open and laparoscopic.
Aside from that, Original Medicare will also provide coverage for any care that you need after your hernia surgery such as:
- Hospital stays
- Doctor visits
Coverage for Hernia surgery is provided by Medicare Part A if it 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 of $371 per day in 2021. After 90 days, Medicare Part A will no longer provide coverage.
However, Medicare Part A provides 60 lifetime reserve days. Using those, Medicare will still provide coverage for your hospital stay after 90 days but you will pay for a copayment of $742 per day.
However, most of the time coverage for hernia surgery is 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 hernia surgery. You will pay for the remaining 20 percent.
Part C and Part D Coverage for Hernia Repair
Medicare Advantage plans (Medicare Part C) also provide coverage for hernia surgery. They must cover all the treatments and services Original Medicare covers. These plans also offer additional benefits. These extra benefits, and associated costs, will vary depending on the plan.
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 hernia surgery. Medicare Part D is a prescription drug plan. Just like Medicare Part C, Medicare Part D plans are provided by private insurance companies and specific coverage will vary from plan to plan.
How Much Does Hernia Surgery Cost?
The cost of hernia surgery ranges from $4,000 to $11,000. The price will vary between open and laparoscopic surgery.
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 BRCA1 and BRCA2 testing?