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Original Medicare usually covers medically necessary back surgeries

Medicare and Back Surgery: What’s Covered?

Back injuries can be brutal because they limit a person’s mobility and range of motion. If you have a back injury, your physician may suggest a treatment plan that involves physical therapy or medication. Sometimes the condition is serious enough to need surgery, or you may go the surgical route if you’ve tried other treatments that haven’t worked. In this case, you want a health insurance plan that will cover the back surgery and the post-op follow-up care you need. 

So, Does Medicare Cover Back Surgeries?

If a doctor states that your back surgery is “medically necessary”, Original Medicare — Parts A and B — will typically cover the procedure. 

Medicare Part A Coverage

Part A is your inpatient hospital care or hospital insurance. It covers:

  • Meals
  • Semi-private rooms
  • General nursing care
  • Drugs — as part of inpatient treatment
  • Generic hospital services and supplies

Medicare Part B Coverage

Part B is your medical care or medical insurance. It covers your physician’s services while you’re hospitalized, PLUS outpatient services once you get released. These may include:

  • Doctor fees
  • Diagnostic imaging tests — X-rays or MRIs

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Common Types of Back Surgery

While Medicare normally covers medically necessary procedures, ask your doctor to make sure that the recommended surgery will be covered. Some common types of back surgery are:   

  • Discectomy
  • Spinal fusion
  • Vertebroplasty 
  • Foraminotomy
  • Artificial disc replacement
  • Laminectomy — aka spinal decompression
  • Nucleoplasty — aka plasma disk compression 

The type of surgery will depend on the cause of your pain or injury, as well as the condition of your spine. In addition to injury, back pain can be caused by degenerative disease or complications with aging.

In some cases, an individual may need non-surgical treatment if chronic back pain persists after surgery.  

You May Need Other Insurance

After surgery, your back will likely feel stiff and sore. It may be hard for you to sit or stand in one position for a long time and may need pain medication in the weeks following your surgery. It could take four to six weeks to return to simple activities, and it usually takes a few months (after surgery) for the bones to heal well. 

While you recover, should you need prescription meds, think about getting additional insurance — like a Part C or Part D plan — to avoid paying high out-of-pocket costs. Medicare Supplement (Medigap) policies are also available when you’re eligible for Medicare. 

Back Surgery Costs After Medicare

It’s hard to say how much back surgery will cost after Medicare chips in. Everyone’s situation is different. Some folks might need an extra day in the hospital which would require additional services.  

Here’s an idea of your potential costs in 2020:

  • Medicare Part A deductible — $1,408
  • Medicare Part B deductible — $198
  • Medicare Part A coinsurance — $0 for days 1-60 for every benefit
  • Medicare Part B coinsurance — typically 20% of Medicare-approved amount

Your doctor and hospital can estimate your out-of-pocket costs for surgery and follow-up care. If you have a Medicare Supplement plan, you can contact the insurance carrier to see what they’ll cover.

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We Help You Find the Right Coverage

It can be difficult to navigate the Medicare maze by yourself. Consider working with a licensed insurance agent, like the ones at Trusted Senior Specialists. We’ll help you find a plan that covers what you need — at a rate you can afford. Call (855) 952-1941 or contact us online for FREE Medicare help.