Does Medicare Cover Hernia Surgeries?

If you have a hernia, the most typical treatment is surgery. And this surgery can be costly.

Seniors who require hernia surgery will often have the question “does Medicare cover hernia surgeries?” You’ll find the answer to that question below. You’ll also find average costs for hernia surgeries and other helpful info.

Does Medicare Cover Hernia Surgeries?

Yes, Original Medicare and some Medicare Advantage plans do cover hernia surgeries. Medicare Part A covers hernia surgeries if it is performed on a hospital inpatient. The coverage includes the anesthesia, meals, nursing care, and the room.

On the other hand, Medicare Part B covers outpatient hernia surgery. It also covers services including the doctor’s fee, facility services, prescription medications given after the surgery, second and third doctor’s opinion (only if the surgery is not an emergency), and anesthesia.

Medicare Part C or Medicare Advantage Plan also cover hernia surgery, and Medicare Part D covers prescribed drugs after hernia surgery.

How Much Does Hernia Surgery Cost?

Depending on many factors, the cost of hernia surgery can vary widely. Whether it is done on an outpatient or inpatient basis is a major factor that affects the costs. It is cheaper to have the surgery done in a surgery center than in a hospital.

Other factors that may affect the price of hernia surgery are the type of surgery and the provider.

Hernia surgery costs on average around $7,500. For inpatient surgery the costs are around $11,500 on average. For outpatient, the average cost is closer to $6,500. These costs, of course, for those who don’t have insurance.

What is a Hernia?

A muscle strain or weakness typically causes a hernia. A person can be at risk for a hernia if he/she is/has:

Chronic straining
Pregnant
Overweight
Cystic fibrosis
Enlarged prostate
Poor nutrition
Smoking

A hernia does not require immediate surgery if it is not life-threatening. Most of the time they are not. But it is essential to inform your doctor if you have one so that they can determine if surgery is necessary or not.

A hernia is a weakness in the muscle tissue that holds up an organ in place. Because the muscle tissues are weak, the organ bulges, thus creating a lump under the skin. A hernia often involves the abdominal wall, somewhere in the belly button or near the groin.

During hernia surgery, the surgeon will push the bulging muscle tissue or intestine back to its place. They will then close and cover the hole in the muscle for the hernia not to occur again.

There are two ways of performing surgery for a hernia. One is open surgery. Open surgery uses general anesthesia to put you to sleep. The surgeon will cut open your skin to push back or remove the herniated tissue. After doing so, the surgeon closes the incision.

The other is the less invasive Laparoscopic surgery. The surgeon will make a few small cuts rather than a large one. Like the open surgery, this too uses general anesthesia.

The abdomen is then inflated with a harmless gas, allowing the surgeon to view the surgical site better. A camera attached to a metal tube is then inserted into one of the cuts, and a piece of surgical mesh is placed under the skin to patch the hole.

Both surgeries have a high success rate, and most patients return home the same day as the surgery.

Types of Hernia

There are four types of hernia. Namely, these are incisional hernia, femoral hernia, hiatal hernia, and umbilical hernia. An incisional hernia may happen to a person who underwent abdominal surgery.

In femoral hernia, the bulge often appears in the upper part of the thighs and is not common in men. In a hiatal hernia, the swelling can appear at the upper part of the stomach. An umbilical hernia occurs when the muscle around the person’s belly does not close after birth.

Note: Medicare coverage changes all the time. And your specific coverage may impact what gets covered and what doesn’t. Always be sure to double check with your health care provider and/or Medicare insurance provider about what is and isn’t covered by your plan.