Does Medicare Cover a Hysterectomy?

Medicare covers a hysterectomy if doctor determines that the procedure is medically necessary. You typically still have to pay a deductible and/or share of the Medicare-approved amount for a covered hysterectomy.

If Medicare covers your hysterectomy, a Medicare Supplement (Medigap) plan can help pay some of your costs Medicare won't cover, such as certain deductibles, copays, coinsurance and more.

What Is a Hysterectomy?

A hysterectomy is the removal of all or part of the uterus and surrounding tissues, such as the cervix. It is one of the most commonly performed procedures in the United States, with roughly one out of three women having one before age 60. There are several reasons a doctor might recommend a hysterectomy, such as:

• Uterine fibroids, which are benign tumors that can cause bleeding and pain. This is the most common reason for hysterectomies in the United States.
  
  
• Endometriosis, which is a condition where cells from the lining of the uterus start growing outside of the uterus. This often causes heavy periods, excessive bleeding and considerable pain.
  
  
• Prolapsed uterus, which is when the uterus drops into the vagina, usually due to weakened pelvic ligaments.
  
  
• Cancer, which accounts for roughly 10% of hysterectomies.
  
  
• Hyperplasia, which is the excessive thickening of the uterine lining. This often causes abnormal or mid-cycle bleeding.

Doctors who perform hysterectomies have several techniques available, which can be tailored to the needs of the woman getting the procedure done.

These range from conventional inpatient procedures that open the abdomen and remove the uterus intact, to outpatient procedures that try to be minimally invasive. Some procedures can be done through a small incision, or even via a robotic arm.

Medicare Coverage for Surgical Procedures

Medicare pays for most surgical procedures a doctor recommends for you.

If you're enrolled in Medicare and need a hysterectomy, your plan is likely to cover the cost of the procedure and recovery, up to set limits.

What Kind of Medicare Coverage Pays for Hysterectomies?

Medicare provides coverage for its beneficiaries in two main ways: Original Medicare and Medicare Advantage. Coverage standards and limits for these two plan options overlap somewhat, but there are significant differences in how each pays for hysterectomies.

Original Medicare

Original Medicare is split into Part A and Part B.

• Medicare Part A is the hospital inpatient benefit that pays for much of the cost of your stay in the hospital, inpatient treatments you receive there and any drugs administered as part of the procedure, such as anesthesia. If you're admitted to the hospital for a few days during your hysterectomy, Part A will cover most of your inpatient costs. 
  
  
• If your hysterectomy is performed as an outpatient procedure, then your surgery may be covered under Medicare Part B. Part B is an optional benefit for Medicare participants, though most Original Medicare beneficiaries opt into it.

Medicare Advantage

Nearly half of Medicare beneficiaries get their benefits through a Medicare Advantage plan.¹ These plans, often called Medicare Part C, are issued by private insurance companies.

All authorized Part C plans include 100% of the same benefits as Original Medicare’s Parts A and B, and plans can offer additional benefits Original Medicare doesn't cover.

Your Medicare Advantage plan representative should have details of how your Medicare plan can help pay for the cost of your hysterectomy.

Your doctor might prescribe various drugs to you before, during and after your hysterectomy.

With the exception of drugs administered in the hospital or clinic, which are covered by Parts A and B, respectively, a Medicare Part D prescription drug plan or a Medicare Advantage plan that includes Part D benefits could help cover the cost of drugs bought at the pharmacy.

Coverage for prescription medication varies between beneficiaries, so it’s a good idea to speak with a representative from your insurance carrier before your surgery to make sure the drugs your doctor prescribes are covered.

Medicare Supplement Insurance (Medigap)

Original Medicare comes with out-of-pocket costs such as coinsurance, deductibles, copays and more. If you need to have a hysterectomy, your Medicare coinsurance and deductible costs could add up quickly. Millions of Medicare beneficiaries get help paying for these types of costs by enrolling in a Medicare Supplement plan, also known as Medigap.

Medigap plans help cover those "gaps" of out-of-pocket costs Medicare doesn't cover. Depending on the type of Medigap plan you have, you could potentially pay $0 out of pocket for your hysterectomy surgery. Medigap plans come with a monthly premium, and you can't have a Medigap plan and a Medicare Advantage plan at the same time.

If you want to learn more, you can compare Medicare Supplement plans online for free, with no obligation to enroll. You can also call to speak with a licensed insurance agent who can help you compare plans and walk you through the application process.

FAQ

How much does a hysterectomy cost with Medicare coverage?

If your hysterectomy is done in the hospital, you likely have to pay your Medicare Part A deductible before your inpatient hospital Medicare coverage kicks in. This deductible is $1,632 per benefit period in 2024.

Outpatient procedures are typically covered by Medicare Part B, which generally includes a 20% coinsurance cost after you meet your Part B deductible.

In 2024, the annual Part B deductible is $240 per year. This means that after you pay for the first $240 of covered care in 2024, you'll pay 20% of the remaining costs.

It's important to note that Original Medicare doesn't include an out-of-pocket spending limit, which means you may be responsible for potentially high out-of-pocket Medicare costs when you have a hysterectomy.

A Medicare Supplement plan can help pay your Medicare Part A deductible and Part B coinsurance costs, and some plans may cover even more costs.

If you have a Medicare Advantage plan, your Medicare hysterectomy costs could vary depending on your individual plan's deductibles, copays, coinsurance, network restrictions and other factors.

Are there any services Medicare doesn’t pay for after a hysterectomy?

Medicare does not typically pay for non-medical support, such as in-home caregiver assistance or alternative therapies. Nutritional support may not be covered, though some mental health counseling could be included under Part B to help with some mood and depression issues associated with having a hysterectomy.

If you have a Medicare Advantage plan, check with your plan provider for details about how your Medicare plan covers a hysterectomy.

Is a hysterectomy dangerous for women over 60?

Most types of hysterectomies are relatively safe for senior women. One study looked at seniors’ hysterectomies done over a 30-year period and found no fatal complications from the procedure.

Your doctor will be able to recommend what is the best course of action for you, based on your health history and other factors.

How long does it take to recover from a hysterectomy?

Recovery time for any surgery varies from person to person and depends on which specific procedure you had. The average hospital stay for the most common type of hysterectomy is between 5 and 7 days.

Recovery at home can take between 2 weeks and 2 months. Less-invasive procedures usually heal sooner, but much of your recovery depends on the support you get after leaving the hospital.