Medicare provides coverage for surgical interventions deemed medically essential. Such services are described by Medicare as those that are “necessary for diagnosing or treating an illness, injury, condition, disease, or its symptoms and are consistent with the accepted standards of medical practice.” Additionally, Medicare stipulates that for services to be considered medically necessary, they must:
- Be appropriate and essential for the diagnosis or cure of your health issue.
- Be employed for the diagnosis, immediate care, and therapy of your health issue.
- Conform to the standards of medical practice within your community and not be primarily for the convenience of yourself or your physician.
To review a catalog of services that Medicare covers, surgeries included, you can conduct a search on the Medicare portal. Should you participate in a Medicare Advantage plan, additional surgical procedures that Original Medicare does not cover might be included. Whether enrolled in Original Medicare or a Medicare Advantage plan, if there’s any ambiguity regarding whether a surgery you’re contemplating or necessitate is insured, consult your healthcare provider, Medicare, or your Medicare Insurance firm. Generally, experimental surgical operations are not insured by either Original Medicare or Medicare Advantage schemes. Prior to undergoing an experimental surgery, verify whether it is insurable by discussing with your healthcare provider.
Subsequent to a surgery that is insured, you may still encounter out-of-pocket expenses through deductibles, coinsurance, or copayment obligations that you must settle.
