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Coverage Options for Surgery

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Health

Surgery can be a frightening prospect, no matter how extensive it is, for more reasons than one. While surgery is always risky, sometimes it is necessary for recovery over a variety of conditions and health concerns. With that said, if you need surgery, you not only want to be sure the surgery will benefit you, but you also want to be sure that you’ll be covered. When it comes to surgery, there are always plenty of complications when it comes to insurance coverage that can affect how much of the hospital bill you’ll be stuck with afterward. If you are in need of surgery, read on to learn more about surgery coverage options.

Options for Surgery Coverage

  • Private Insurance
  • Medicare
  • Medicaid

Insurance

When it comes to insurance coverage for surgery, the specifics will vary based on the insurer. Therefore, you’ll need to pay attention to what your individual insurer covers when it comes to medical costs, and then compare that with the costs necessary for your surgery, to figure out what your out of pocket costs will be. Additionally, there will be pre-op tests and imaging, anesthesia, surgery fees and other costs to consider. Most plans will cover a majority of your surgery costs, provided they are deemed medically necessary. Most cosmetic surgeries will not be covered unless there is also a health concern related to the surgery, such as a nose job for dealing with a breathing problem.

Highlights:

  • Will cover all medically necessary surgeries
  • Coverage depends on insurer
  • Will cover a majority of costs

Medicare

Medicare will cover most medically necessary surgeries that are life-saving or will improve the health of an individual. Seniors on Medicare will be covered usually for a variety of surgeries as necessary, but no exact co-pay can be predicted as costs will vary based on the kind of surgery performed and the tools necessary. However, you can get a better idea by asking the doctor or hospital how much you will need to pay for the surgery, as well as care after the surgery.  Cost can also vary depending on inpatient and outpatient care status. If you want to limit co-pays and deductibles, having a Medicare Advantage plan can help you reduce these costs.

Highlights:

  • Some out of pocket costs
  • Co-pays will vary depending on surgery
  • Amount varies depending on inpatient or outpatient care

Medicaid

Medicaid offers coverage for low-income families. For Medicaid, out of pocket costs will vary by the state. However, out of pocket costs cannot be imposed on families in need of emergency surgery. As with the other options, Medicaid will provide medically necessary or advantageous surgeries as needed. They will even cover weight loss surgery provided the individual has met the requirements which include a letter from a primary care doctor, necessary documentation and a supervised weight loss program. When all options have been exhausted or surgery seems the most beneficial option, Medicaid will cover it.

Highlights:

  • Covers medically necessary surgery
  • No out of pocket costs for emergencies
  • Covers weight loss surgery

Conclusion

Surgery is a serious step towards treating any condition, but before you go into surgery, it’s important to be prepared for the costs. While private insurance may offer more leeway when it comes to coverage, Medicare and Medicaid may come with smaller co-pays.