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Does Medicare Cover Reconstructive Surgery?

Written by Evens Stevenson

There is a lot of questions from Medicare enrollees about what Medicare does and doesn’t’ cover for participants. One of the common questions that we receive is if Medicare pays for any reconstructive surgery. Unfortunately, several different situations can impact the answer to that question. In short, the answer is – it depends.

It’s vital that you understand what Medicare covers and the expenses that you’ll be responsible for paying out-of-pocket. Any misunderstandings could lead to you having thousands of dollars of bills and having no way to pay for them.

Medicare and Reconstructive Surgery

does medicare cover reconstructive surgeryReconstructive surgery is exactly what it sounds like. It’s surgery that is used to alter the look or function of the body. It can be used to improve certain areas of the body or change any appearances that you don’t like. There are dozens of different reasons that you could be considering reconstructive surgery, or there could be several reasons that your doctor is suggesting that you receive one of these procedures. Before you have one of the surgeries done, you’ll need to ensure Medicare will cover the services. Otherwise, you’ll have thousands of dollars sucked out of your bank account.

To answer the question quickly, in most cases, Medicare Parts A and B are not going to pay for the vast majority of the expenses related to reconstructive surgery. That’s because the majority of these surgeries aren’t medically necessary. If your doctor hasn’t said that you need this surgery to maintain a healthy life or not having it could drastically harm you in some way, you’ll be paying for those bills yourself in most cases.

There are several different requirements that you’ll have to meet if Medicare is going to pay their portion of the expenses for the surgery. The first is that the procedure has to be deemed “medically necessary” by a doctor or physician. Additionally, Medicare must agree that the service is necessary.

The other requirement is that the procedure must be completed at a facility that accepts Medicare reimbursement for their services. In most cases, you shouldn’t have a problem finding a surgeon that accepts Medicare, the majority of hospital and departments allow compensation, but it’s an important factor to take note of before you continue the process. It can save you trouble down the road if you ask about Medicare reimbursement upfront.

There are two different ways that you can check to see if your surgery is going to be covered under Medicare. The best way is to simply ask your doctor about it, they should be able to answer you.

The other way is to visit the official Medicare website. They have a goods and service page that can show you if your particular surgery is going to be covered under Medicare Parts A and B.

Medicare Supplemental Insurance Policies and Reconstructive Surgery

While Medicare is an excellent program that covers dozens of different medical expenses, there are some bills that they won’t pay for, luckily there are several health care options you can choose from to get additional coverage. You can enroll in a Medicare Advantage plan or a Medigap plan if you aren’t satisfied with the insurance coverage that you’re getting through Original Medicare. Each of these options has different advantages and disadvantages that you have to weigh to decide which one is going to work best for you.

With a Medicare Advantage plan, there is a chance that you could get additional coverage for your reconstructive surgery. Every Advantage plan is different depending on the provider, which means that every plan has different benefits and covered expenses. You’ll need to contact the provider directly to ask about reconstructive surgery and the requirements for reimbursement.

The other options for additional insurance coverage is a Medigap plan. These are an excellent tool to offset hospital bills that can wipe out your savings and leave your retirement dream a retirement nightmare. While they are great at providing protection that Medicare doesn’t provide, they aren’t going to help with reconstructive surgery, but you should still have an understanding of the Medigap policies, because they can be a lifesaver for your retirement savings account.

Medigap policies are sold by insurance companies and operate just like any other insurance policy that you purchase. You’ll apply for coverage and then pay monthly premiums to the insurance company.

When you start shopping for Medigap, you’ll notice there are ten options. These additional insurance plans an affordable option or getting the health care that you deserve.

Because there are ten different plans, you’ll have to weigh the advantages and costs of each plan to decide which one is best for your needs. When looking at plans, you need to find one which will give you the perfect protection to help you get the most out of your retirement.

The first is your health. If you’re in bad health or have several preexisting conditions, you’ll want to consider investing in a more comprehensive Medigap plan, like Plan F, which covers ever hole that is left by Medicare. On the other hand, if you’re in good health and have a great family history with you can consider getting a lesser plan that will save you money on monthly premiums.

While everyone would like to have as much insurance protection as possible, not everyone can afford those plans. Before you apply for any Medigap plan, take a look at your finances and decide how much you can spend on additional coverage. Supplemental insurance policies shouldn’t break your bank.

Summary

There are a lot of things Medicare pays for, but there are a lot of things it doesn’t. If you’re one of the millions of Americans who wants additional coverage, then you should consider one of the Medigap policies.

We know Medicare and Medigap coverage isn’t simple. It’s confusing, luckily, we are here to clear up any confusion.

If you are left with any concerns about your healthcare coverage, or you want to know which policy is best for you, we can do that for you. We are here to do all of the hard work and bring the best insurance policy quotes.

 

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