Does Medicare Cover Back Surgery?

Back pain is a common condition around the globe. Low back pain is one of the most common health complaints among seniors, leading to a significant increase in back surgeries over the past two decades. 

The Centers for Disease Control and Prevention (CDC) describes how lower back pain is classified in terms of duration of symptoms:

  • Acute: less than four weeks
  • Subacute: four to 12 weeks
  • Chronic: more than 12 weeks

Medicare Benefits Solutions

Jan 7, 2022

timer 3 minutes read

Many people with acute lower back pain do not seek medical care because the condition resolves itself. If you do visit a doctor, the first course of treatment may be anti-inflammatory drugs, heat and/or physical therapy. 

If non-surgical approaches do not alleviate your pain, your doctor may talk to you about the pros and cons of back surgery. If the surgery is medically necessary, Medicare benefits may help cover the cost of the procedure, the facility and the surgeon’s fees.

Medicare benefits for back surgery

If you have surgery in the hospital, Part A Medicare benefits cover your:

  • Semi-private room
  • Meals
  • General nursing services
  • Necessary medication and other supplies
  • Inpatient rehabilitation care if your doctor certifies you need intensive rehabilitation, your doctor’s oversight and coordinated care

You are responsible for the Part A deductible ($1484 in 2021). If you require an inpatient stay beyond 60 days, you are responsible for coinsurance, starting at $371 per day.

Part B Medicare benefits cover: 

  • Hospital outpatient diagnostic and treatment services
  • Outpatient surgery, X-rays and casts
  • Physical therapy
  • Your doctor’s services, whether you are an inpatient or outpatient
  • Second surgical opinion

Your share of the cost is the Part B deductible ($203 in 2021) and 20% coinsurance. If you use the services of a hospital outpatient department, the facility can charge you a copayment. 

Use your Part D Medicare benefits for any medications your doctor prescribes to mitigate your pain or facilitate your recovery. Part D plans vary, so make sure that medications prescribed are included in your plan’s formulary or list of covered drugs.

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Types of back surgery

Depending on your situation, your surgeon may perform one of the following surgical procedures:

  • Discectomy: Remove all or a portion of a vertebral disc.
  • Artificial disc replacement: Implant an artificial disc that mimics the functions of a natural disc.
  • Fusion: Join two vertebrae.
  • Laminectomy: Remove bone and widen the spinal canal.
  • Minimally invasive: Leverage medical advancements and innovative techniques for a faster recovery and fewer complications.

Prevention versus cure

The National Spine Health Foundation offers these suggestions for avoiding back and neck pain:

  • Maintain good posture so that your spine is aligned correctly.
  • Learn about workplace ergonomics, so you can protect your back and neck when you work in an office.
  • Practice safe lifting to reduce stress on your back.
  • Try relaxation exercises to lower your overall stress level.
  • Find the best sleeping position for your back.
  • Be aware that smoking impacts your bone density, connective tissues and spinal health.
  • Follow healthy behaviors for proper nutrition and weight management.
  • Exercise to help prevent back pain and hasten recovery if pain does develop.

Resources

  • National Spine Health Foundation: The website includes a patient journey guide to support you from diagnosis through post-surgery recovery.

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    Medicare Benefits Solutions is a non-government website. This is a solicitation for insurance. By submitting information on this site, I am providing my written consent for Medicare Benefits Solutions, herein after referred to as “Medicare Benefits”, which is a brand operated by HealthCompare Insurance Services Inc., its sales agents, or affiliates to contact me (even if I’m on a state or national do not call registry) at the phone number or email address listed to provide me with quotes or information about Medicare Advantage, Medicare Supplement, and Medicare Part D plans. I further consent to such calls or texts sent via autodialer, automated technology, prerecorded message and/or artificial voice. I understand my consent is not a condition of purchase and that I can revoke my consent at any time via medicarebenefits.com/about-us/contact-us. Additional charges may apply to SMS, call, or Internet usage depending on your data providers.

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