Does Medicare Cover Back Surgeries?

If you have a back injury, your doctor may recommend a treatment plan that includes physical therapy or medication. Sometimes the condition is severe enough to require surgery, or you may choose surgery after undergoing other unsuccessful treatments. In that case, you want a Medicare plan that will cover the surgery you need, plus all the post op follow-up care.  

Original Medicare Typically Covers Back Surgery

If a doctor deems your back surgery as medically necessary, Original Medicare (Parts A and B) will usually cover it. 

Part A

Medicare Part A is your hospital insurance. It covers inpatient hospital care, including:

• Meals
• General nursing
• Semi-private rooms
• Drugs as part of inpatient treatment
• General hospital services and supplies

Part B

Medicare Part B is your medical insurance. It covers your doctor’s services while you’re in the hospital and outpatient services after you’re released, which may include doctor fees and diagnostic imaging tests like x-rays or MRIs.

You May Need Additional Insurance

If you need prescription medication during recovery, consider additional insurance, like a Part D (prescription drug) or Part C (Medicare Advantage) plan to avoid paying excessive costs.    

Medicare Supplement plans (Medigap) are also available when you qualify for Medicare. If you have Medicare and this kind of additional insurance, it will affect what you pay for your back surgery and recovery.  

What Type of Surgery Might Be Best?

This will depend on the root of your pain and the condition of your spine. Back pain is often caused by:

• Injury
• Degenerative disease
• Complications with aging 

An orthopedic specialist will perform a physician exam and may request an MRI or xray to evaluate your needs. Then, the specialist will go over your options with you.  

Common Types of Back Surgery

While Medicare usually covers medically necessary procedures, check with your doctor to make sure that it covers the recommended surgery. Here are the common types of back surgery:   

• Discectomy
• Spinal fusion
• Artificial discs
• Vertebroplasty 
• Foraminotomy
• Laminectomy/spinal decompression
• Nucleoplasty/plasma disk compression 

In certain cases, a person may require non-surgical treatment for chronic back pain after surgery.  

How Much Will Back Surgery Costs After Medicare?

It’s hard to determine exactly how much back surgery will cost after Medicare payments. The details of the services you may need are uncertain. For example, some people might require an extra day in the hospital beyond what was expected.

Your potential costs will look like this:

• Medicare Part A deductible is $1,408 in 2020
• Medicare Part B deductible is $198 in 2020
• Medicare Part B coinsurance is usually 20% of Medicare-approved amounts
• Medicare Part A coinsurance is $0 for days 1 to 60 for every benefit

Your doctor and hospital should be able to estimate how much you’ll need to pay for your surgery and follow-up care. If you have a Medigap policy, you can contact the carrier to see what costs they will cover. 

You can also find examples of back surgery costs on healthline.com. 

We Help You Find the Coverage You Need

It can be challenging to navigate the Medicare system on your own. The agents at Bobby Brock Insurance can help you find a plan covering what you need at a price you can afford. Call (662) 844-3300 or contact us online for free Medicare help.