Does Medicare Part A Cover Outpatient Surgery?
- Medicare Part A covers certain costs related to inpatient surgery, but Medicare Part B covers outpatient surgery when it meets Medicare coverage guidelines.
Part A is the part of Medicare that pays for inpatient care you get during a stay in the hospital. Part A benefits are also available for multiday stays in various inpatient and residential care centers.
This benefit does not usually pay for outpatient procedures, which mostly fall under the umbrella of Part B coverage.
What Are the Parts of Medicare?
People who are new to Medicare can easily get lost in the multiple different plans, parts and other divisions of coverage they have to navigate.
Medicare benefits are grouped according to how they are delivered.
Which Parts of Medicare Pay for Medical Procedures?
Outpatient treatments, including outpatient surgery, are covered by Part B.
A procedure that is normally done on an outpatient basis, such as nail clipping for people with diabetes, might be billed as an inpatient service if you are already in the hospital for an unrelated matter, such as an invasive surgery.
Costs Not Covered by Medicare
Even if your outpatient procedure is paid for by Medicare, you might still owe some money as a co-payment or as a deductible. In these cases, you must pay any balance you owe before Medicare can assist with the rest of the bill.
If you have a Medicare Supplement Insurance (Medigap) policy, which is a private insurance plan designed to work alongside your regular Medicare benefits, your Medigap plan can help pay for some of your copays, coinsurance and other costs you may face with Medicare-covered outpatient surgery.
FAQ
What Does Part A Pay For?
Part A benefits pay for inpatient care in hospitals and residential care facilities
Which Part of Medicare Pays for Outpatient Care?
Most outpatient procedures fall under Medicare Part B benefits. Medicare Advantage plans include Part B benefits, and so they also offer the same coverage.
How Do I Pay for Outpatient Procedures with Medicare Part B?
Providers that are authorized to bill Medicare for outpatient services can directly invoice the program. Present your Medicare benefits card (or the ID card your Medicare Advantage plan sent you if you have Medicare Part C) at the time of payment.
