After a surgery, should I expect out-of-pocket costs?

Question

Andrew Zurbuch, MBA · Accepted Answer

If you have a Medicare Advantage plan, yes, expect some out of pocket costs. It could be a Copay or a Coinsurance, which is a % for example 20%. You should receive Explanation Of Benefits in the mail after claims. Make sure to review them. Thank you.

Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Steve Houchens · Answer

Expecting out of pocket cost for surgery would depend on what type plan you have. Most times with a Medicare Supplement plan there are generally no additional costs unless you need to meet your part B deductible. With advantage plans you may expect copays or coinsurance cost but these should be explained to you when enrollment happens so that you know fully what to expect.

Answered by Steve Houchens on August 10, 2025

Agent Licensed in KY & TN

Answered by Steve Houchens Medicare Insurance Agent

Tracy Davis · Answer

That is vague question because it would be different depending on which plan you are utilizing. If you have Medicare Supplement (G or N) and have not satisfied your $257 deductible then you will owe up to that deductible. If you have already satisfied your deductible then you should not have any out of pocket costs accrued. However, if you are on a Medicare Advantage plan then you will be billed the set copayment for that procedure based upon which plan you are on with which carrier.

Answered by Tracy Davis on August 11, 2025

Broker Licensed in IN, CO, FL & KY, NM, OH & TN

Answered by Tracy Davis Medicare Insurance Agent

Jack Mayer · Answer

Your policy limits are spelled out and you should check to determine what if any out of pocket expenses will be incurred. Not so with a Supplement, you know what your cost will be but with an Advantage plan you will pay a co-pay for 70% of health services rendered

Answered by Jack Mayer on August 11, 2025

Agent Licensed in CA & NV

Answered by Jack Mayer Medicare Insurance Agent

Andy Kelly · Answer

It depends. If you have a Medicare Supplement, in addition to Parts A and B, once your Part B annual deductible is met, you should have no other out-of-pocket costs. If you have a Medicare Advantage plan you likely will have out-of-pocket costs, both in terms of co-pays and your MOP (maximum out of pocket).

Answered by Andy Kelly on August 12, 2025

Agent Licensed in WA & OR

Answered by Andy Kelly Medicare Insurance Agent

Patricia Graham · Answer

You will likely have expenses, depending on the insurance coverage you choose. There are limitations on hospital stays and skilled nursing facilities. There are co-pays on durable medical equipment if you require help at home, which would not be covered.

Answered by Patricia Graham on August 10, 2025

Agent Licensed in WA

Answered by Patricia Graham Medicare Insurance Agent

Jody Hill · Answer

It depends on the plan you are on.  Medicare supplement or medicare advantage plans.  Medicare advantage plans have copays.

Bruce Resnick · Answer

Investigate the other letter plans available in your state. Plan N may have the porential to save you money.

After a surgery, should I expect out-of-pocket costs?

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After a surgery, should I expect out-of-pocket costs?

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Medicare Agents HubA non-government resource website

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A non-government resource website