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

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 what outpatient surgery is, 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? With an outpatient procedure, you’re able to leave the hospital the same day. Advances in medical processes and medication are making that more possible than it’s ever been.

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

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 ensure there aren’t any 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.

Keep in mind that the 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 that 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 of Original Medicare.

Depending on your plan, your out-of-pocket costs for an 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%.

Keep in mind that Medicare Advantage plans generally have a specific list of approved medical providers, and outpatient services in hospitals 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.

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

If you’re ready to sort through the Medicare options and choose the right plan for you, we’re here to help. Contact us to get started today!

Reach out to a licensed insurance agent if you have questions.

More From this Author

Related Articles


Please enter your comment!
Please enter your name here

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Stay Connected


Latest Articles