Does Medicare Cover Prolapse Surgery?

A pelvic organ prolapse occurs when the pelvic floor muscles weaken. This causes the organs to shift from their regular positions.

Although non-surgical options exist, surgery may be required in the worst cases of prolapse. There are many types of surgery for pelvic organ prolapse.

So a common question many people have is, “does Medicare cover prolapse surgery?” In this article, we answer that question in clear, plain English. You will also find the average costs of prolapse surgery for those who have to pay for it out-of-pocket.

Does Medicare Cover Prolapse Surgery?

The short answer is yes; Medicare will cover the cost of prolapse surgery. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your prolapse 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 prolapse surgery. This plan provides coverage for your prolapse surgery if it is considered medically necessary. Your healthcare provider must first order the operation for Original Medicare to provide coverage.

Coverage for prolapse surgery is provided by Medicare Part A if it takes place in an inpatient setting. 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 copay each day you are still in the hospital.

On the other hand, coverage for prolapse surgery is provided by Medicare Part B when it takes place in an outpatient setting. Once approved, Medicare Part B covers 80 percent of the costs of prolapse surgery. You will pay for the remaining 20 percent.

Part C Coverage for Prolapse Surgery

Medicare Advantage plans (Medicare Part C) also provide coverage for prolapse surgery. They cover everything Original Medicare covers and offer some additional benefits as well. Each plan is different though, so the additional benefits a plan offers and the costs will depend on the plan you have.

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

Medicare Part D plans provide coverage for medications you need after prolapse surgery. Part D is a prescription drug plan. Like Medicare Part C, Medicare Part D plans are provided by private insurance companies.

How Much Does Prolapse Surgery Cost?

The average cost of prolapse surgery ranges from $6,000 to $9,000. The exact cost depends on the specific surgery being performed.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. 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.