A hernia repair is a common medical procedure that must be performed when an organ or other tissue pushes through the muscle wall of the abdomen. Hernias do not generally get better on their own, so surgery is often necessary to address them. Hernia surgery is often covered by Medicare, and there are a few different insurance plans that you can use that offer coverage.
What is Hernia Surgery?
In many cases, hernias are not life threatening and do not require immediate repair. However, it is important to notify your physician if you do have a hernia so that they can evaluate it and perform a surgical procedure if needed. In many cases, a hernia occurs because a piece of the intestines pushes through the abdominal wall. This commonly happens near the belly button or near the groin. Sometimes, the intestine or tissue can become trapped inside the abdominal wall, which is called incarceration. Incarceration can cause the blood flow to the tissue to get cut off and may cause permanent damage.
During hernia surgeries, the surgeon will push the bulging tissue or intestine back into place and will close and cover the hole in the muscle to prevent the hernia from reoccurring. There are two main types of hernia repairs: open surgery and laparoscopic surgery. Both of these surgical options tend to have a high success rate, and most patients are able to return home the same day of the surgery.
Open surgery involves being put to sleep under general anesthesia. Then, the surgeon will cut into the skin, push the herniated tissue back into place or remove it if necessary, and close the incision with stitches. For larger hernias, a piece of mesh may be placed below the skin to help hold the tissue in place below it.
Laparoscopic surgery is less invasive and only a few small cuts are made instead of one larger one. General anesthesia is often used for this procedure as well. The surgeon then inflates the abdomen with a harmless gas, which allows them to better view the surgical site. Then, a camera attached to a metal tube is inserted into one of the incisions and a piece of mesh is guided into place below the skin to patch the hole. If the hole is large enough, stitches or staples may be required to hold the mesh in place.
As far as recovery time goes, laparoscopic surgery often has a shorter recovery, and patients are often able to get back to their daily routine about one week earlier than those undergoing open surgery. In many cases, laparoscopic surgery will be used, but this mainly depends on the surgeon’s preference and the severity of the hernia.
Does Medicare Cover These Surgical Procedures?
In most cases, hernia surgeries are performed in outpatient facilities. They also do not often require a hospital stay following the surgery. Because of this, Medicare Part B benefits often provide coverage for these procedures. Medicare Part B benefits often cover 80 percent of the total cost of the outpatient surgery as long as your deductible has been met. As of 2019, the Part B deductible is $185 per year.
If you do end up requiring an inpatient stay in a hospital or other facility due to complications or recovery precautions, Medicare Part A may provide coverage for this portion of your care. Medicare Part A serves to cover medically-necessary inpatient costs, and it pays for 80 percent of the Medicare-approved amount like Part B.
If an inpatient stay is required, Part A may help cover the costs, nut you may be responsible for copayments, deductibles, and premium costs associated with your Medicare plan. As of 2019, the Part A annual deductible limit is $1,364. However, these hospital stays are not often required with hernia surgeries due to their less-invasive nature and good recovery and success rates.