Does Medicare Part A cover outpatient surgery, or is that strictly under Part B?

Question

Don Hudson · Accepted Answer

Medicare Part A does not cover Outpatient surgery. Medicare Part B covers outpatient surgery with 20% coinsurance you are responsible for.

Charise Karjala · Answer

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Jonathan Potter · Answer

Part A covers hospital and Part B covers medical. Think of part A as the physical side of coverage and part B is the human side. Part B will cover the doctors fees and Part A will cover the facilities and other such fees.

Answered by Jonathan Potter on April 14, 2025

Broker Licensed in UT, AZ, CA & 14 other states

Answered by Jonathan Potter Medicare Insurance Agent

Steven Bleicher · Answer

If there is one main regulation to memorize it is that: an 80/20 ratio is the main rule of Medicare. Thus, if you are operated on in a hospital, Part A will pay the 80% and your alternate plan will pick up all or most of the remaining 20%. However, if that same operation takes place in a free-standing surgical center outside of a hospital, yes, only Part B will pay the 80% and the same 20% exists as above-mentioned. Just recall that anything of an experimental nature will NOT be paid for until the CDC & CMS combine to approve that treatment.

Answered by Steven Bleicher on May 30, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Norman Smith · Answer

Part A is strictly for your Hospital issues. Your Outpatient surgery and care are covered by your Part B only.

Fred Manas · Answer

No, Medicare Part A does not cover outpatient surgery; it's typically covered by Medicare Part B. Part A primarily covers inpatient hospital stays and services, while Part B covers outpatient care, including doctor's visits, lab tests, and outpatient surgeries. 
Elaboration:
Medicare Part A:
This part of Medicare focuses on hospital coverage, including inpatient stays, skilled nursing facility care, and some home health services. It's essentially the hospital insurance component of Medicare. 
Medicare Part B:
This part covers a wide range of outpatient services, including doctor's visits, diagnostic tests like X-rays, and outpatient surgeries. It also covers services received in the hospital as an outpatient, such as surgery performed in a hospital's outpatient department. 
Outpatient Surgery:
When you receive surgery in a hospital or outpatient clinic, but don't stay overnight, it's considered outpatient surgery and is covered under Medicare Part B. 
Cost-Sharing:
Under Part B, after you meet your annual deductible, Medicare generally pays 80% of the approved amount for covered outpatient services, including surgery. You are responsible for the remaining 20% coinsurance. Additionally, you may incur extra costs for anesthesia, lab tests, or other related services.

Steve Brauer · Answer

Typically, the "outpatient surgeries" are covered under Part B of Medicare. There may be some situations where you are actually in the hospital and go home that same day, which may be covered under Part A of Medicare

Answered by Steve Brauer on April 8, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Marcie Barnes · Answer

Medicare Part A is only for inpatient services.  Medicare Part B is for anything outpatient, including outpatient surgery and doctor visits.

Natalee Nimmo · Answer

That would be Medicare Part B. Part A is going to be hospitalization, (if you admitted into the hospital), skilled nursing, also known as rehab, hospice, home healthcare, and your first 3 pints of blood. Everything else is going to be under part B and if it’s a prescription, it would be under part D.

Answered by Natalee Nimmo on April 8, 2025

Broker Licensed in SC, FL, GA & KY, MO, NC & TX

Answered by Natalee Nimmo Medicare Insurance Agent

Jessica Breland · Answer

No, Medicare Part A is Inpatient coverage. Part A covers things like being an inpatient in a hospital, Hospice, Home Health & Skilled Nursing. Outpatient surgery would be covered by Part B.

Mike Sosso · Answer

Medicare Part A:  does not pay for outpatient surgery.  Part A covers inpatient services to include inpatient hospital care up to 150 days and inpatient skilled nursing care for up to but no more than 100 days per stay.  Part A has a modest deductible of $1676 for 2025, and is subject to per day coinsurance begining after day 60 of inpatient hospital care and day 20 of in-patient skilled nursing care. Medicare Part A does not pay for Long Term Care services. 

Medicare Part B: pays for outpatient surgery and all other Medicare appoved outpatient services like like Doctor Visits, Lab Work, Outpatient Surgery, Physical Therapy, etc. Part B has a monthly cost to obtain coverage. The cost in 2025 for most Americans is $185 per month. If your Adjustable Gross Income (AGI) is higher than most, the premium for Part B is higher.

Johnnie Jeter · Answer

Medicare part A may cover outpatient surgery, but part B typically covers the cost. For example if you need a more complex procedure part A may cover the cost.

Does Medicare Part A cover outpatient surgery, or is that strictly under Part B?

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Does Medicare Part A cover outpatient surgery, or is that strictly under Part B?

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