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Medicare will provide coverage for some, but not all, types of back surgeries.
In this article, we’ll take a look at spinal fusion surgery. This is a procedure that removes a spinal disk. Surgeons do this by fusing the two bones with grafts or metal screws.
If this is a type of surgery that you or a loved one could benefit from, you may wonder, “Does Medicare cover spinal fusion surgery?” In this article, we answer this question in clear, plain English.
You will also find the average costs of spinal fusion surgeries and other helpful info.
Does Medicare Cover Spinal Fusion Surgery?
The short answer is yes; Medicare will cover the cost of spinal fusion surgery. But this is not the case 100% of the time.
You have to meet certain conditions for Medicare to cover spinal fusion surgery. This is often the case with this Medicare insurance. Below we look at what these are so you know what to expect.
Original Medicare Coverage of Spinal Fusion Surgery
Original Medicare (Medicare Part A and Part B) provides coverage for spinal fusion surgery and other back operations. This Medicare plan provides coverage for some back surgeries but not all. Among those Original Medicare covers include spinal fusion surgery.
Yet, note that Original Medicare provides coverage for spinal fusion surgery only if it is medically necessary. First, your healthcare provider needs to order the operation. Then, Original Medicare may provide coverage.
When is Coverage Provided by Part A?
Medicare Part A provides coverage for spinal fusion if your procedure happens in an inpatient setting. Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days.
From the 61st day to 90 days, Medicare Part A will still provide coverage. Yet, you will pay a copayment each day you are 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 there will be a copayment.
When is Coverage Provided by Part B?
Medicare Part B covers spinal fusion surgery when it takes place in an outpatient setting.
Once approved, Medicare Part B covers 80 percent of the costs of spinal fusion surgery. You will pay for the remaining 20 percent.
Medicare Advantage Coverage of Spinal Fusion Surgery
Medicare Advantage plans (Medicare Part C) also provide coverage for spinal fusion surgery. This is because all Part C plans must cover everything Original Medicare covers.
Part C plans also cover some things that Original Medicare does not. What these things are and how much they cost will vary from plan to plan.
Medicare Part D plans provide coverage for medications that you need after spinal fusion surgery.
Part D is a prescription drug plan. Like Medicare Part C, private insurance companies also provide Medicare Part D plans.
How Much Does Spinal Fusion Surgery Cost?
For those who do not have health insurance coverage, spinal fusion surgery can be costly. In the U.S., the average cost ranges from around $17,000 to over $45,000, with the average being around $30,000. Costs will vary depending on whether it’s performed in an inpatient or outpatient facility, as well as the specifics of your case.
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.
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 upright walkers?