Does Medicare Cover Appendix Surgery?

Appendix surgeries are used to treat appendicitis, a common medical emergency involving inflammation of the appendix. They’re one of the most commonly performed surgeries in the United States.

In fact, there are approximately 300,000 hospital visits in the United States each year for appendicitis-related issues — and many of them involve surgery.

If you ever need appendix surgery, know that Medicare will cover it.

When does Medicare cover appendix surgery?

Medicare covers appendix surgery, known as an appendectomy, when it’s medically necessary. Medicare will consider your appendix surgery to be medically necessary if it’s being used to treat a condition or its symptoms.

Since an appendix surgery is normally an emergency procedure to treat appendicitis, it will meet Medicare’s definition of medically necessary.

How much does the average appendix surgery cost?

Your costs for appendix surgery will depend on the type of surgery you have, your recovery time, and other factors or complications specific to your case.

Your costs can be affected by:

  • the type of appendix surgery you have
  • the hospital where you have your surgery
  • any antibiotics you need
  • any anesthesia you need
  • your hospital stay following a procedure

For example, if you’re able to have your appendix surgery as an outpatient, your costs will likely be much different than if you need to stay in the hospital for a few days.

Your hospital stay will also affect the part of Medicare you’re using, which will affect your costs. You’ll be covered under Medicare Part A for an inpatient stay, whereas you’ll be covered under Medicare Part B if you have outpatient surgery.

Since appendix surgery is generally an emergency procedure, you likely won’t have time to ask your doctor beforehand about costs. However, there a few numbers to keep in mind that can help you estimate:

  • You’ll need to pay your Part A deductible before Medicare will cover your costs.
  • As with Part A, you’ll need to pay your Part B deductible before Medicare will cover your costs.
  • Part B services have a coinsurance payment of 20 percent of the Medicare-approved amount. The Medicare-approved amount is the set cost Medicare has agreed to pay for a procedure. Even if you end up with an inpatient stay, you might pay Part B coinsurance for services such as the ambulance ride to the hospital.
  • Part A has a copayment per day if you stay in the hospital for more than 60 days.
  • Your Medicare Advantage (Part C) plan might have its own deductibles and copayments for surgeries.

Which Medicare plans may be best for you if you ever need appendix surgery?

You generally can’t plan an appendix surgery in advance. However, it’s a good idea to know what each part of Medicare will cover if you ever need an emergency appendix surgery:

  • Medicare Part A. Medicare Part A is hospital insurance. It will cover you if you need an inpatient stay following your appendix surgery.
  • Medicare Part B. Medicare Part B is medical insurance. It will cover your emergency room costs, the ambulance ride, and your surgery if you have the procedure as an outpatient.
  • Medicare Part C. Medicare Part C, also known as Medicare Advantage, covers everything that parts A and B do. Advantage plans often cover additional services beyond parts A and B as well. They might also have lower copayments.
  • Medicare Part D. Medicare Part D is prescription drug coverage. It won’t cover your appendix surgery. However, it can cover any antibiotics or pain medication you’re prescribed following surgery.
  • Medigap. Medigap is Medicare supplement insurance. It lowers your out-of-pocket costs of using parts A and B, together known as original Medicare. It won’t cover your surgery, but it can cover your copayment and coinsurance costs

There are a few other things to keep in mind when you’re considering parts of Medicare.

For example, most Medicare Advantage plans have a network of providers. You generally pay more to see providers who aren’t in your plans’ network, and you might not even have coverage at all. However, since an appendix surgery is usually an emergency, this might not apply.

Most Medicare Advantage plans do allow you to use an out-of-network hospital in an emergency. It’s a good idea to know your plan’s policy in case an emergency ever occurs.

Why people need appendix surgery

Appendix surgery is used to treat appendicitis. Appendicitis occurs when your appendix becomes inflamed and swollen. This is generally caused by infection and can happen to people at any age.

Appendicitis is always a medical emergency because it can cause your appendix to rupture. If it does, bacteria can spread to your other organs, causing a serious and potentially fatal infection.

So, removing your appendix is generally the best option to treat appendicitis.

If you think you’re experiencing appendicitis, you should go to the hospital right away. Symptoms of appendicitis include:

  • swelling in your abdomen
  • sudden pain in your stomach that spreads from your naval down to the lower right side of your abdomen
  • nausea or vomiting
  • constipation or loose bowels
  • loss of appetite
  • fever

What happens during appendix surgery?

Appendix surgery is called an appendectomy, and there are two different types. The type you have will depend on:

  • your age
  • your overall health
  • the progression of your appendicitis

Types of appendix surgery include:

  • Open appendix surgery. You might have an open surgery if your appendix has already burst or if you’ve had abdominal surgery in the past. During the procedure, a doctor will make an incision in your abdomen, remove your appendix, and clean out the cavity to stop the spread of bacteria. Your incision will be stitched close once the procedure is complete
  • Laparoscopic appendix surgery. Laparoscopic surgery is a common surgical procedure. During the procedure, a doctor will make a series of small incisions in your abdomen and then inflate your abdomen with carbon dioxide. A long tube will then be inserted into your abdomen, allowing the doctor to see your appendix on a computer screen and remove it.

You’ll be under anesthesia during either procedure. In some cases, you might go home the same day you have your appendix surgery; in other cases, you might need to stay for in the hospital for a couple of days.

Generally, you’ll recover from a laparoscopic procedure faster than an open surgery. Your recovery might also depend on how severe your appendicitis was and any other health conditions you have.

Appendicitis is an emergency. Seek emergency care immediately if:

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