Does Medicare Part A Cover Outpatient Surgery? 5 Interesting Facts.

Greg Wilson

Updated on:

MEdicare PArt A

    When it comes to outpatient services, you're probably wondering does Medicare Part A covers outpatient surgery. Find out here if your surgery gets covered.

    How Does Medicare Part A Cover Outpatient Surgery?

    The number of outpatient surgeries was 129 million in 2018 and is expected to grow to 144 million by 2023. If you're one of the millions who need surgery this year, you might wonder if your Medicare coverage applies.

    Does Medicare Part A cover outpatient services? Many people know Medicare Part A as “hospital insurance,” so it's common to think that outpatient surgery is covered under this section.

    However, when you look at outpatient surgery, you'll see that it's more like a doctor's visit than an inpatient stay.

    Let's take a look at outpatient services and how Medicare covers them.

    What is Outpatient Surgery?

    When you get surgery, you stay in the hospital. Right? 

    Not anymore. Outpatient surgery is widespread for many procedures.

    What is outpatient health care? You can leave the hospital on the same day with an outpatient procedure. Advances in medical processes and medication are making that more possible than ever.

    You'll be monitored in a care unit when you have outpatient surgery as you wake up from anesthesia. You'll be discharged when you can perform various simple tasks, including using the restroom.

    You cannot drive yourself home after an outpatient procedure. You'll need to have someone drive you home and stay with you for 24 hours to prevent complications.

    Coverage for Outpatient Surgery With Original Medicare

    Because you're not staying in the hospital for one or more nights, the surgery isn't considered an inpatient service. That means that Medicare Part A won't cover this.

    Instead, you'll find coverage under Medicare Part B. This part also covers other medically necessary services and preventive care.

    Remember that outpatient surgery must be medically necessary to have coverage from Original Medicare. You will pay your Part B deductible and the 20% copayment, and Medicare will cover the rest.

    There is no annual limit to out-of-pocket expenses with Original Medicare, so costs can add up quickly.

    Outpatient Hospital Services Coverage With Medicare Advantage

    Another way to use Medicare to cover your health needs is with Medicare Advantage. Private health insurance companies administer these plans. They are an all-in-one replacement for Original Medicare.

    Depending on your plan, your out-of-pocket costs for outpatient surgery could be much less than with Original Medicare. For instance, you may pay a set copayment instead of a percentage.

    Another advantage is that many Medicare Advantage plans have an annual maximum out-of-pocket limit. Once you hit that limit, your care is covered 100%.

    Remember that Medicare Advantage plans generally have a specific list of approved medical providers, and outpatient hospital services might require preauthorization.

    Find the Coverage You Need for Outpatient Services

    Medicare helps you with medically necessary outpatient services. However, this coverage is under Part B rather than Part A of Original Medicare.

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    You may have more benefits if you have a different type of plan, such as Medicare Advantage. However, outpatient professional services may need preauthorization before they can move forward.

    If you qualify for Medicare but don't know where to start, we have licensed insurance agents ready to answer your questions and help you enroll in Medicare Advantage, Medicare Supplement Insurance, and Prescription Part D plans.

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