Medicare inpatient surgery is performed when you are admitted to the hospital. Inpatient surgical services fall under Medicare Part A; you are responsible for the benefit period deductible and any coinsurance or copays that you may incur.
For a short inpatient surgery stay of 60 days or less, you’ll pay up to your Part A deductible of $1,556. Beyond 60 days, you’ll pay a daily coinsurance that starts at $389 and increases after 90 days. Learn more about how much you’ll pay for inpatient surgery with Medicare.
How Do You Find Out Your Medicare Inpatient Surgery Cost?
Inpatient surgery costs under Medicare depend on the length of your hospital stay. Expect to pay up to your $1,556 Part A deductible, which covers the first 60 days. After 60 days, you’re subject to a daily coinsurance payment. Below you will find the schedule of your Medicare payment responsibility in 2022.
|2022 Part A Costs|
|Days 1 to 60||
|Days 61 to 90||
|Days 91 and beyond||
These costs apply to days within a benefit period. Medicare Part A benefit periods end when you are out of the hospital or skilled nursing facility for more than 60 days. If you are readmitted after 60 days, you start a new benefit period.
Joan goes into the hospital Jan. 4 for six days. Medicare Part A will cover everything during that hospitalization except the deductible of $1,556. If she is readmitted on Feb. 2, she does not pay a new deductible.
If Joan is readmitted May 7 and has a 62-day hospitalization, she will be responsible for another $1,556 deductible plus $389 dollars per day for the two additional days.
Does Medicare Cover Inpatient Surgery?
|Medicare Plan||Does it cover inpatient surgery?||What part of inpatient surgery does it cover?||Your out-of-pocket costs|
|Medicare Part A||Yes||Medicare Part A will cover the hospital stay and all associated costs while you are inpatient or in a skilled nursing facility, minus deductibles and any coinsurance.||Part A deductible for the first 60 days; daily coinsurance for days 61 and beyond.|
|Medicare Part B||No||Medicare Part B will pay for preoperative visits and any postoperative care that is outpatient.||After the Part B deductible, you are responsible for 20% coinsurance of all outpatient costs.|
|Medicare Advantage Plan (MA Plan)||Yes||This private insurance policy is required to cover all basic services that Original Medicare covers. Coverage is the same as Medicare Part A.||See your plans benefits summary as all MA Plans have different payment responsibilities.|
|Medicare Supplement (Medigap) Plans||Yes||Medigap covers Parts A and B services.||Medicare Supplement Plans cover the Part A deductibles and coinsurance that would generally be your responsibility. It also covers an additional 365 days for hospitalizations when Medicare benefits are depleted.|
|Medicare Part D||No||Part D covers outpatient medications generally provided by a pharmacy. All inpatient drugs are covered under Part A.||Please see your plan details for additional information.|
What Kinds of Inpatient Care Does Medicare Cover?
Medicare Part A covers inpatient care. These services include:
- Inpatient surgery
- Skilled nursing care
How Medicare covers common surgeries and inpatient care:
|Surgery||How It Is Covered Under Medicare|
|Total knee replacement||
Does Medicare Require Preauthorizations for Inpatient Surgery?
Original Medicare does not require preauthorizations for Medicare inpatient surgery claims. MA Plans usually do require prior authorization for inpatient surgeries to ensure they are medically necessary.
What if you need emergency surgery and do not get a preauthorization?
Emergency surgery does not require prior authorization. However, coverage for emergency medical costs are subject to the terms of your health plan. This specifically applies to MA Plans, since each plan is designed differently.
There are minimal prior authorization requirements under Original Medicare.
Does Medicare Pay for Inpatient Rehab Services?
Skilled nursing care is given by medical professionals or technical personnel such as a nurse, physical or occupational therapists, or doctors to treat, observe, and rehabilitate a medical condition. This care is generally given in an inpatient setting, but can be done at home. To qualify for skilled nursing care, you are required to have:
- A qualifying three-day inpatient hospitalization
- The condition starting during a hospitalization or in a skilled nursing facility
- Your doctor’s decision that you need daily skilled care
How Long Will Medicare Cover Your Hospital Stay?
Medicare will cover your hospital stay for up to 90 days. After 90 days, you’ll dip into your lifetime reserve days, which provide Medicare coverage beyond the standard 90-day period. You have just 60 lifetime reserve days for the entire time you use Medicare. Once these lifetime reserve days are depleted, you’re responsible for all costs.
Learn More From Our Sources
- Medicare.gov | Medicare Costs at a Glance | Last accessed November 2022
- Medicare.gov | Skilled Nursing Facility (SNF) Care | Last accessed November 2022
- Medicare.gov | What’s Medicare Supplement Insurance (Medigap)? | Last accessed November 2022