Does Medicare Cover a Hysterectomy? What It Costs

Medicare, the federal health insurance program, provides coverage for a wide range of medical services, including certain surgical procedures. Beneficiaries often wonder about coverage for specific treatments like a hysterectomy. This procedure can be covered by Medicare when specific medical criteria are met, ensuring access to necessary care.

Original Medicare Coverage

Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), provides coverage for medically necessary hysterectomies. Medicare Part A covers inpatient hospital stays, encompassing the surgical procedure itself, the hospital room, and related services if the hysterectomy requires an inpatient admission.

Medicare Part B covers physician services, such as the surgeon’s fees, anesthesiologist’s services, and any necessary diagnostic tests leading up to the surgery, like ultrasounds or biopsies. Part B also extends to outpatient follow-up care. Even if the hysterectomy is performed during an inpatient hospital stay, the professional services of the doctors involved are covered under Part B.

Coverage for a hysterectomy under both Part A and Part B is contingent on medical necessity. This means a physician must determine the procedure is required to treat a specific health condition, rather than being an elective or cosmetic choice. Common medical conditions that warrant a hysterectomy include symptomatic uterine fibroids, severe endometriosis, unmanageable heavy bleeding, or certain gynecological cancers.

Different surgical approaches, such as abdominal, vaginal, laparoscopic, or robotic hysterectomies, are covered if the underlying medical necessity for the procedure is established. Medicare focuses on the medical need for the removal of the uterus itself, rather than the specific technique used by the surgeon. The choice of surgical method is a clinical decision between the patient and their healthcare provider, based on the medical condition and individual circumstances.

Understanding Out-of-Pocket Costs

While Original Medicare covers medically necessary hysterectomies, beneficiaries are responsible for certain out-of-pocket costs. For an inpatient hysterectomy, the Medicare Part A deductible applies per benefit period. In 2025, this deductible is $1,676.

For services covered under Medicare Part B, an annual deductible must be met before Medicare begins to pay its share. In 2025, the Part B annual deductible is $257. After this deductible is satisfied, beneficiaries pay a coinsurance of 20% of the Medicare-approved amount for most doctor services and outpatient care. This 20% coinsurance applies to the surgeon’s fees, anesthesiology, and any outpatient diagnostic tests or follow-up visits.

Original Medicare does not have an annual out-of-pocket maximum, meaning there is no cap on the amount a beneficiary might pay in coinsurance and deductibles in a given year. Medicare Supplement Insurance (Medigap) plans can help cover some of these out-of-pocket expenses, such as deductibles and coinsurance.

Medicare Advantage and Prescription Drug Coverage

Medicare Advantage plans, also known as Medicare Part C, are offered by private insurance companies approved by Medicare. These plans are required to cover at least everything that Original Medicare (Parts A and B) covers, including medically necessary hysterectomies. While the scope of covered services is similar, Medicare Advantage plans have different cost-sharing structures, such as copayments and coinsurance, compared to Original Medicare.

These plans may also operate with specific provider networks, requiring beneficiaries to receive care from doctors and hospitals within the plan’s network for full coverage. Some Medicare Advantage plans may require referrals or prior authorizations for certain services, including surgical procedures. A key difference from Original Medicare is that Medicare Advantage plans include an annual out-of-pocket maximum, which limits the total amount a beneficiary pays for covered medical services in a year.

Prescription Drug Plans (Medicare Part D) provide coverage for medications. For a hysterectomy, a Part D plan covers any necessary post-operative pain medication or other drugs required during recovery. These plans involve their own costs, which can include monthly premiums, annual deductibles, and copayments or coinsurance for prescription drugs. The specific out-of-pocket costs for medications will vary depending on the chosen Part D plan and the drug tier of the prescribed medications.