Does Medicare Cover Back Surgery?
- January 12, 2024
- Reviewed by John Krahnert
Original Medicare (Part A and Part B) covers back surgery that is considered medically necessary by a doctor.
How much you will pay out of pocket for your back surgery depends on the procedure, where you receive the surgery, and how you get your Medicare benefits.
Medicare Advantage plans (Part C) also cover back surgery and have an annual out-of-pocket spending limit, which Original Medicare doesn't offer.
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This means if you spend a certain dollar amount out of pocket for your back surgery, your plan will pay 100 percent of the cost for covered services that go beyond the annual out-of-pocket limit. If you only have Original Medicare, there's no limit to the amount of spending you may have to pay for your back surgery.
How much does back surgery cost with Medicare?
Back surgeries can vary widely in cost. According to the chiropractic publication To Your Health, back surgery can cost as much as tens of thousands of dollars.1
With any medical procedure, make sure you ask your doctor what all is involved and how much it might cost.
Medicare out-of-pocket costs
What can you expect to pay out of pocket? It’s hard to say. If you are enrolled in Medicare Part A and Part B, you can likely expect both to contribute to your care. Medicare Part A will help pay for costs associated with hospital inpatient stays and skilled nursing care, while Medicare Part B will help pay for the cost of the procedures itself, doctor fees, and other outpatient costs.
Medicare Part A and Part B each have their own deductibles, copayments and coinsurance that you could be responsible for paying.
If you receive your Medicare benefits from a Medicare Advantage plan, your plan will have its own out-of-pocket costs and rules.
You may need prescription medications to help you with the recovery process. You can receive prescription drug coverage through Medicare Part D. Part D benefits can be delivered from a stand-alone Prescription Drug Plan or a Medicare Advantage plan with Part D benefits (MA-PD). Out-of-pocket costs for prescription drugs can vary by plan.
It’s always a good idea to familiarize yourself with how your Medicare coverage works.
Does Medicare cover laser spine surgery?
Medicare may help pay for laser spine surgery if it is medically necessary. However, it may not help pay for facility fees – only doctor and procedure fees.2
Laser spine surgery is a minimally invasive alternative to traditional back surgery. A doctor will make a small incision and use a laser or another type of instrument to treat the problem area. It may be effective for certain spinal conditions, but some patients may not be good candidates for the procedure.
Medicare Advantage plans cover back surgery and may offer other benefits
A Medicare Advantage plan (also called Medicare Part C) is sold by a private insurance company and provides the benefits of Medicare Part A and Part B into one single plan.
Some Medicare Advantage plans may also offer other benefits not covered by Original Medicare, which can include some costs savings if your plan will cover more of your out-of-pocket costs for back surgery.
Explore Medicare Advantage plan benefits in your area
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1 Smith, J.C., MA, DC. Back Surgery: Too Many, Too Costly and Too Ineffective. (June, 2011). To Your Health. Retrieved from www.toyourhealth.com/mpacms/tyh/article.php?id=1447.
2 Laser Spine Institute. Common Questions. Retrieved from www.laserspineinstitute.com/patient-process/spine-back-questions.
About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
