If your back surgery is deemed medically necessary by a doctor, original Medicare (Part A and Part B) will typically cover it.
If you experience back pain, talk to your doctor about recommended treatment that may include:
- physical therapy
They can let you know why they feel these procedures are necessary and if they’re covered by Medicare.
Medicare coverage for back surgery typically mirrors coverage for other medically necessary surgeries, hospital stays, and follow-ups.
Medicare Part A (hospital insurance)
Medicare Part A covers inpatient hospital care, providing that:
- the hospital accepts Medicare
- you’re admitted per an official doctor’s order indicating that you need inpatient hospital care
You may need approval for your hospital stayfrom the hospital’s Utilization Review Committee.
Medicare inpatient hospital care coverageincludes:
- semi-private rooms (a private roomonly when medically necessary)
- general nursing (not private-dutynursing)
- drugs (as part of inpatienttreatment)
- general hospital services andsupplies (not personal care items like slipper socks or razors)
Medicare Part B (medical insurance)
Medicare Part B covers your doctor’s services during your hospital stay and outpatient services following your release from the hospital.Other insurance, such as Medicare Supplement plans (Medigap), Medicare Part D (prescription drug), or Medicare Advantage plans are available to you when you qualify for Medicare.
If you have this type of additional insurance along with Medicare, it will impact the price you pay for your back surgery and recovery.
It’s difficult to determine exact costs prior to back surgery, because the specifics of the services you may need are unknown. For example, you might need an extra day in the hospital beyond what was predicted.
To estimate your costs:
- Ask your doctor and hospital howmuch they think you’ll have to pay for your surgery and follow-up care. Checkto see if there are services being recommended that Medicare doesn’t cover.
- If you have other insurance, suchas a Medigap policy, contact them to see what part of the costs they will coverand what they think you’ll have to pay.
- Check your Medicare account(MyMedicare.gov) to see if you have met your Part A and Part B deductibles.
This table provides an example of potential costs:
|Medicare Part A deductible||$1,408 in 2020|
|Medicare Part B deductible||$198 in 2020|
|Medicare Part B coinsurance||typically 20% of Medicare-approved amounts|
Medicare Part A coinsurance is $0 for days 1 to 60 for each benefit.
Examples of back surgery costs
The Medicare.gov website makes the prices of certain procedures available. These prices do not include physician fees and are based on national Medicare averages from 2019.
This table can give you an indication of what you might have to pay for some of the services involved in a surgical procedure on your back.
|Diskectomy||The average cost of a diskectomy (aspiration of lower spine disc, accessed through the skin) in a hospital outpatient department is $4,566 with Medicare paying $3,652 and the patient paying $913.|
|Laminectomy||The average cost of a laminectomy (partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine) in a hospital outpatient department is $5,699 with Medicare paying $4,559 and the patient paying $1,139.|
|Spinal fusion||The average cost of spinal fusion (fusing together two or more vertebrae so that they heal into a single, solid bone) in a hospital outpatient department is $764 with Medicare paying $611 and the patient paying $152.|
Although Medicare typically covers medically necessary surgery, check with your doctor to be certain that Medicare covers the type of surgery they’re recommending.
Common types of back surgery include:
If your doctor indicates that back surgery is medically necessary for you, typically it will be covered by original Medicare (Part A and Part B).
Determining how much back surgery will cost you after Medicare payments is difficult because the exact services you will access is unknown.
Your doctor and hospital should be able to offer some educated estimates.