Medigap policies can help pay for certain costs related to surgeries that Original Medicare does not fully cover. Medigap policies do not cover the cost of the surgery itself, but help pay co-pays, coinsurance, excess charges, and deductibles.
What is Medigap?
Medigap policies are private insurance policies that supplement Original Medicare (Parts A and B) by covering costs that Original Medicare does not cover, such as co-payments, deductibles, and coinsurance. Learn more about Medigap here.
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What surgeries do Medigap plans pay for?
Medigap policies do not cover the cost of the surgery itself, only the costs not covered by Original Medicare.If Medicare pays a portion of the surgery then most Medigap plans will pay the remaining amount. Some of the surgeries that Medicare typically pays a portion of include:
- Cataract surgery
- Joint replacements (e.g. hip and knee replacements)
- Heart surgery (e.g. bypass surgery)
- Gastrointestinal procedures (e.g. colon resection)
- Neurological procedures (e.g. brain surgery)
- Gynecological procedures (e.g. hysterectomy)
Medicare coverage for surgeries and procedures can vary depending on the specific medical condition being treated, the type of procedure being performed, and the patient’s individual circumstances. Additionally, Medicare typically covers only medically necessary surgeries, and certain limitations or requirements for coverage may exist. Beneficiaries should discuss their specific coverage with their doctor and consult their Medicare plan for more information.
How much will Medigap pay for surgeries?
As we explained above, Medicare Parts A and B cover certain surgeries and procedures and Medigap plans can help pay for related out-of-pocket costs, such as deductibles, and the 20% of the coinsurance that Original Medicare does not cover. This payment of the 20% not covered by Medicare can save you serious amounts of money depending on the procedure. Note: Some Medigap plans, such as plan F, cover the part B deductible which is often required before surgery, and others, such as Medigap plan G, do not.
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Medigap also pays for Excess Charges that your doctor may pass on to you as part of the surgery fees. This can be an additional 15% on top of the fees mentioned above. Many Medigap plans will cover these Medicare excess charges. Learn more about Medicare’s excess charges and how to avoid them here.
Senior65.com recommends that you review your options and compare the costs and benefits of Medigap and Original Medicare to make an informed decision. Contact us at 800-930 7956 and we can help you compare the costs and benefits of Medigap to make an informed purchasing decision.