Quick Answer
Yes. Medicare covers medically necessary surgery. Part A covers inpatient hospital surgery, and Part B covers outpatient surgical procedures at 80% after the deductible. Elective cosmetic surgery is not covered. A Medigap plan can cover the remaining 20% coinsurance.
Coverage Comparison by Plan Type
| Plan Type | Coverage | Notes |
|---|---|---|
| Original Medicare (Part A) | Covered | Inpatient hospital surgery when medically necessary |
| Original Medicare (Part B) | Covered (80%) | Outpatient surgery at 80% after deductible |
| Medicare Advantage | Covered | Must cover same as Original Medicare; network rules apply |
| Medigap | Covers Cost-Sharing | Covers Part A deductible and Part B 20% coinsurance |
| Medicare Part D | Rx Coverage | Covers post-surgical prescription medications |
Understanding Your Coverage Options
Original Medicare (Part a & B)
Medicare Part A covers inpatient surgical procedures when they are medically necessary. This includes the hospital stay, operating room, anesthesia, nursing care, and other hospital services. You pay the Part A deductible per benefit period.
Medicare Part B covers outpatient surgical procedures at 80% after the annual deductible. This includes same-day surgeries performed at ambulatory surgical centers or hospital outpatient departments. You are responsible for the remaining 20% coinsurance.
Medicare covers a wide range of surgeries including heart surgery, joint replacements, weight loss surgery (case-by-case), and reconstructive procedures. Elective cosmetic surgery is not covered. Some procedures require prior authorization.
What It Covers
- Heart surgery (open-heart, angioplasty, stents, robotic cardiac surgery)
- Joint replacement surgery (knee, hip) when medically necessary
- Reconstructive plastic surgery after injury, mastectomy, or disease
- Weight loss surgery (bariatric) for morbid obesity (case-by-case)
- Anesthesia for covered surgical procedures
- Same-day outpatient surgery
- Pre-operative visits when surgery is medically necessary
What It Doesn't Cover
- Elective cosmetic surgery (facelift, body contouring)
- Procedures not deemed medically necessary
- Most dental surgery (except jaw-related conditions)
Part A: $1,736 deductible per benefit period (2025). Part B: 20% coinsurance after $283 annual deductible.
Medicare Advantage (Part C)
Medicare Advantage plans must cover all medically necessary surgeries that Original Medicare covers. However, plans may have different cost-sharing structures, require you to use in-network surgeons, and may need referrals or prior authorization.
Some Medicare Advantage plans offer lower out-of-pocket maximums for surgical procedures, which can provide cost savings compared to Original Medicare without a Medigap plan.
Medicare Supplement (Medigap)
Medigap plans cover the same services as Original Medicare and pay for the remaining cost-sharing. For surgery, this means covering the Part A deductible, Part B coinsurance (20%), and potentially excess charges.
With a comprehensive Medigap plan like Plan G, your out-of-pocket costs for a covered surgery could be limited to just the Part B deductible and your monthly premium.
Medicare Part D
Medicare Part D covers prescription medications you may need before or after surgery, including pain medications, antibiotics, blood thinners, and anti-inflammatory drugs. Your costs depend on your plan's formulary and tier structure.
Common Surgery Costs with Medicare
| Surgery Type | Typical Cost Range | Medicare Coverage |
|---|---|---|
| Heart surgery (open-heart) | $70,000 - $200,000+ | Covered (Part A/B) |
| Knee replacement | $30,000 - $70,000 | Covered (Part A/B) |
| Hip replacement | $30,000 - $65,000 | Covered (Part A/B) |
| Bariatric surgery | $15,000 - $35,000 | Case-by-case (Part A/B) |
| Cataract surgery (outpatient) | $3,000 - $7,000 | Covered (Part B) |
| Rotator cuff surgery | $6,000 - $15,000 | Covered (Part A/B) |
| Cosmetic surgery | Varies | Not covered |
✦ Exceptions and Limitations
Elective Cosmetic Surgery
Medicare does not cover cosmetic surgery performed solely to improve appearance. However, reconstructive surgery after an accident, injury, or mastectomy is covered when medically necessary.
Prior Authorization Requirements
Some elective surgeries require prior authorization from Medicare before the procedure. Your surgeon's office should handle this process, but it can take additional time.
Dental Surgery Limitations
Medicare Parts A and B do not cover most dental surgery. Exceptions include jaw-related conditions such as jaw cancer or a broken jaw. A separate dental plan may be needed.
Weight Loss Surgery Criteria
Bariatric surgery is approved on a case-by-case basis. You must have a BMI of 35 or higher with at least one obesity-related condition, and the procedure must be FDA-approved.
✦ Frequently Asked Questions
David Haass
AuthorDavid Haass is the Chief Technology Officer and Co-Founder of Elite Insurance Partners and MedicareFAQ.com.
Ashlee Zareczny
ReviewerAshlee Zareczny is a licensed Medicare agent in all 50 states dedicated to educating those eligible for Medicare.