Medicare can cause a great deal of confusion among its members. With four parts, copayments, deductibles, coinsurance, deadlines, and more to consider, you can easily get overwhelmed navigating through all the Medicare details. Medicare can be trickier when it comes to surgery. Now, let’s take a look at specific details of what surgeries Medicare covers.
Repair After an Accidental Injury
Trauma or injury to the body can cause severe damage to skin, bones, or muscles. Complicated wounds like burns are common examples of injuries that require surgery and are covered under Medicare.
Medicare can help pay for breast reconstruction procedures that meet the requirement. However, unlike the standard health insurance plans, Medicare doesn’t offer a pre-approval method, so your surgeon may not be able to determine if the surgery will be considered medically necessary before operating. So, you will likely be informed by your surgeon before the surgery that you may be responsible for the cost of the surgery. Those that meet the requirement set by Medicare are expected to be covered.
Weight Loss Surgery
Your Medicare insurance plan will cover weight loss surgery, which can help you lose a considerable amount of weight. The procedures covered by Medicare include:
- Adjustable gastric banding
- Vertical gastric banding
- The Roux-en-Y bypass
- Biliopancreatic diversion.
Medicare usually requires you to participate in a 6-month supervised weight loss program through a primary care doctor or bariatric surgeon before Medicare pays for surgery. You may be eligible if you have a body mass index of 35 and at least one health problem related to obesity.
Medicare doesn’t always cover treatments or surgical approaches for weight loss. This includes:
- Weight loss programs
- Supplemented fasting
- Intestinal bypass
- Gastric balloon
- Open or laparoscopic vertical banded gastrectomy
- Open adjustable gastric banding
- Open or laparoscopic sleeve gastrectomy
- New or experimental procedures or treatments
Correction of a Malformation
Medicare also covers plastic surgery needed to treat congenital irregularity. Some congenital disorders may cause structural anomalies and may affect both function and appearance. For instance, you can treat cleft lip with plastic surgery.
Medically Necessary Cosmetic Procedures
Usually, cosmetic surgery is performed to improve appearance. While Medicare never covers purely cosmetic surgeries, many common cosmetic surgeries are covered when medically necessary. For instance, a rhinoplasty, known as a nose job, is done to remove a bump or straighten a crooked nose. Medicare will not pay for a nose job when the main reason why it is performed is to improve your appearance. However, if you are experiencing difficulty breathing and a nose job is medically necessary, Medicare will provide coverage.