- Surgery is generally the recommended treatment for hernias.
- Medicare will cover hernia surgery as long as it’s medically necessary.
- Medicare will cover hernia surgery whether you have it as an inpatient or outpatient.
Hernias are a fairly common medical condition. Not all hernias need treatment, but surgery is the primary treatment for ones that do.
If you need hernia surgery, Medicare will cover it as long as it’s considered medically necessary.
Depending on where you have your surgery, you might be covered under Medicare Part A, Medicare Part B, or your Medicare Advantage plan. A Medigap plan can help you lower the costs of hernia surgery.
Medicare covers any hernia surgery that’s medically necessary. So, as long as your doctor determines that surgery is the best way to treat your hernia, Medicare will cover it.
When you use original Medicare (parts A and B together), the surgery is often covered under Part B. This is because hernia surgery is generally performed as an outpatient procedure, and Part B is medical insurance.
Medicare Part A, on the other hand, is hospital insurance. So, you’d use Part A for a hospital stay and Part B for services you receive at a doctor’s office or clinic.
Medicare covers multiple types of hernia surgery if they’re medically necessary. This includes both open and laparoscopic hernia surgeries.
Plus, Medicare will cover any care you need after your surgery, including:
- hospital stays
- follow-up visits
The cost of hernia surgery will depend on several factors, such as:
- the type of hernia you have
- the procedure that’s done
- the provider
For example, it’s generally much cheaper to have a procedure at a surgery center than at a hospital.
In October 2020, Medicare’s procedure comparison tool shows the estimated cost to you of laparoscopy for an incisional hernia to be $894 at a surgery center but $1,585 at a hospital. This holds true for all types of hernia surgery.
Your costs will also depend on where you’re having your surgery and what part of Medicare you’re using. Some numbers to keep in mind include:
- You’ll pay 20 percent of the cost of services when you use Medicare Part B. Medicare will pay the other 80 percent.
- Medicare Part B has a deductible. You need to pay this before Medicare will cover your surgery.
- Medicare Part A doesn’t have a coinsurance amount until your 60th day of hospitalization.
- Medicare Part A has a deductible that you’ll need to pay before coverage starts.
Let’s go back to the example of a laparoscopy for an incisional hernia procedure.
According to Medicare, the average total cost for the procedure at a surgery center is $4,476. Medicare Part B pays 80 percent, or $3,581, as of October 2020. That leaves you with $894 to pay. If you still had some or all of your deductible remaining, you’d need to pay that in addition to the $894.
You can get coverage for hernia surgery using multiple parts of Medicare. In some cases, you might use a combination of parts to get coverage for your surgery. You can get coverage using:
- Medicare Part A. Medicare Part A is hospital insurance. It’ll pay for your hernia surgery if you have it while you’re an inpatient at the hospital.
- Medicare Part B. Medicare Part B is medical insurance. It’ll cover your hernia surgery if you have it as an outpatient at a surgery center, office, or at a hospital’s outpatient surgery center.
- Medicare Part C. Medicare Part C is also known as Medicare Advantage. It covers everything that original Medicare does and often includes coverage for additional services, too. It’ll cover your hernia surgery no matter where you have it.
- Medicare Part D. Medicare Part D is prescription drug coverage. It won’t cover your hernia surgery itself; however, it’ll cover the prescriptions you need after surgery.
- Medigap. Medigap is Medicare supplement insurance. It covers the out-of-pocket costs of original Medicare. It can cover your surgery coinsurance and other costs that would normally be billed to you.
A hernia happens when an organ pushes through the muscle wall that surrounds it. This is normally caused by muscle strain or weakness. Hernias can result from factors including:
- overall health
Most hernias happen in your abdomen, but they can happen anywhere. You might notice a bulge under your skin where the hernia occurred.
The symptoms of a hernia can vary depending on the type of hernia you have. Some hernias have no symptoms. Others may cause symptoms like pain, swelling, difficulty swallowing, or nausea.
Hernias don’t go away on their own and can have serious — and even life threatening — complications.
Surgery is generally the only treatment for hernias. However, you might not need surgery if your hernia is mild and not causing you pain. Your doctor will instead monitor your hernia and prescribe medications that can help prevent further symptoms.
You’ll need surgery if your hernia continues to grow or is causing you any symptoms.
The goal of any hernia surgery is to close the opening in the affected muscle wall.
There are two primary types of hernia surgery: open and laparoscopic. The right procedure for you may depend on the location of your hernia and on your overall health.
When you have open surgery, a doctor will make an insertion near the site of your hernia. The doctor will then carefully push the organ back into place and stitch the affected muscle wall. A doctor might use surgical mesh to secure the site.
A laparoscopic procedure is much less invasive and normally has a faster recovery time. During laparoscopic hernia surgery, a doctor will make a series of small incisions, then use a camera to see the hernia. They’ll stitch up the site to repair the hernia.
Not all hernias can be treated with a laparoscopic procedure. Your doctor will let you know which type of surgery is right for your hernia.
After surgery, you’ll likely be prescribed medication to help with the pain. Your recovery time will depend on which procedure you have and how your body responds to it.
When is a hernia an emergency?
Seek emergency care If you have a hernia and develop any of the following symptoms:
- The bulge from your hernia doesn’t go away when you lie flat on your back.
- The bulge from your hernia becomes red or purple.
- You have a high fever.
- You have chills.
- You have blood in your stools.
- You experience nausea or vomiting.
- You experience constipation or trouble passing gas.
- You have severe and increasing pain near the hernia site.
- Surgery is the primary treatment for a hernia.
- Medicare will consider your surgery medically necessary and cover it when your doctor thinks it’s the best treatment for your hernia.
- Medicare Part B will cover your hernia surgery when you have it outpatient; Medicare Part A will cover it when you have the procedure while you’re an inpatient in a hospital.
- You can also get coverage when you have a Medicare Advantage plan.