What Does Medicare Cover for 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 (Part A and Part B together), the surgery is often covered under Part B. This is because Part B is medical insurance, and hernia surgery is generally performed as an outpatient procedure.

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, including open and laparoscopic surgeries.

Plus, Medicare will cover any care you need after your surgery, including:

• hospital stays
• medications
• 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
• where you have the procedure done

For example, it’s generally much cheaper to have a procedure at a surgery center than at a hospital.

In June 2024, Medicare’s procedure comparison tool showed the estimated cost to you of a repair of anterior abdominal hernia to be $391 at a surgery center but $726 at a hospital. This holds true for all types of hernia surgery.

Your costs will also depend on what part of Medicare you’re using. Some numbers to keep in mind include:

• You’ll pay 20% of the cost of services when you use Medicare Part B. Medicare will pay the other 80%.
• Medicare Part B has a deductible. You need to pay this before Medicare will cover your surgery. In 2024, the Part B deductible is $240.
• 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. In 2024, the Part A deductible is $1,632.

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. 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, but 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 typically be billed to you.

A hernia happens when an organ pushes through the muscle wall that surrounds it. This is usually caused by muscle strain or weakness. Hernias can result from factors including:

• injury
• illness
• age
• overall health
• genetics

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 usually has a faster recovery time. During laparoscopic hernia surgery, a doctor makes a series of small incisions, then uses a camera to see the hernia. They 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 (Part C) plan.