Estimating surgery costs with Medicare coverage

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Facing a surgery is scary enough without worrying about your finances. Medicare is there to help reduce your surgery bills and stress levels. Read on to get a better idea of your out-of-pocket surgery costs.

What Does Medicare Cover?

Medicare covers many expenses related to essential surgical procedures, but it does not cover elective surgeries (such as cosmetic surgeries) unless they serve a medical purpose. For example, Medicare will cover an eye lift if the droopy lids impact vision.

Medicare Part A covers expenses related to your hospital stay as an inpatient. The amount you’ll pay depends on your recovery time. You won’t incur any coinsurance if your inpatient stay lasts between one and 60 days. However, if there are complications and you spend more time in the hospital, you could find yourself liable for coinsurance.

If your hospital stay extends beyond 60 days, days 61 to 90 will cost you (2018) $335 per day in coinsurance. If your hospital stay exceeds 90 days, you’ll pay $658 for every “lifetime reserve” day you spend in hospital. If you are still in hospital after exhausting your “lifetime reserve days,” Medicare Part A will no longer cover your expenses.

This might sound scary, but such long hospital stays are far from the norm. According to Face the Facts USA, the average hospital stay in the United States is just 4.9 days. That’s only slightly longer than Mexico, which reports the shortest average hospital stays out of all Organization for Economic Cooperation and Development countries at 3.9 days. Even Americans requiring major surgeries like liver transplants and open-heart procedures are typically home in around seven days. That doesn’t mean people needing surgery don’t stay in the hospital longer than 60 days, but the number of people who do is very rare.

Medicare Part B covers doctor services, including those related to surgery, some kinds of oral surgery, and other care you’ll receive as an outpatient. Medicare Part B will usually pay 80 percent of your eligible bills, leaving you to pay the remaining 20 percent, according to the Medicare website.

If you have Medicare Supplement Insurance (Medigap), this policy may also cover some expenses related to your surgery. All Medigap plans cover Part A coinsurance on long hospital stays. Many also cover all or part of Part B coinsurance and Part A and Part B deductibles.

How Can I Estimate My Costs?

It’s difficult to determine exactly how much you’ll spend on your surgery because prices for individual surgeries vary depending on your procedure and healthcare facility. Doctors may also need to perform unexpected procedures if there are complications.

However, you can ask your doctor or a customer care representative at your hospital or healthcare facility what you can expect to pay. Make sure to clarify whether you’ll be an inpatient or outpatient, as this can influence the costs of surgery.

Minimize Your Surgery Costs

Unless you have Medigap to take care of it, you must pay your yearly deductible for Medicare to cover the maximum amount of your surgery expenses. You can confirm whether you’ve already paid by viewing your last Medicare Summary Notice. You should have received a paper copy, but you can also find it online via MyMedicare.gov. Make sure you’ve paid your Part A deductible if you’ll be an inpatient. Paying the Part B deductible is important for doctor’s services and outpatient care.

If you haven’t paid your deductible yet, add this amount to your expected expenses. In 2018, Medicare lists the annual deductible for Part A at $1,340 and for Part B at $183.

Make sure your doctor or medical provider accepts assignment of the Medicare charges. If your physician does not, you’re liable for the difference between what he or she charges and what Medicare will willingly pay, up to a maximum threshold, according to the legal website NOLO.

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