Learning Center > 5 Common Medical Procedures (and Costs) for Seniors

5 Common Medical Procedures (and Costs) for Seniors

Medicare spending is trending upward. In 2018, Medicare benefit payments totaled $731 billion - an increase from $462 billion in 2008.

And Medicare-aged people can sometimes have chronic conditions and limitations, which can lead to costly medical services and treatment - all while living on a modest income. So it might be important for you to know the cost of an impending medical procedure to treat your condition.

But finding the true cost of a medical procedure can be tricky, so we used Medicare's procedure price lookup tool to find rough costs of every procedure covered under Medicare.

It's not a perfect science though: The average costs found on Medicare's procedure price lookup tool are based on Original Medicare. That said, the prices do not account for physician fees and Medicare Advantage or Supplemental plans. Still, the tool can give you a ballpark estimate for medical procedures so you can plan ahead and budget accordingly.

With this in mind, let's take a look at five common procedures for Medicare recipients and the costs associated with each procedure.

(Note: All costs are based on Medicare's procedure price lookup tool. Current Procedural Terminology (CPT) is a medical code used to report medical, surgical and diagnostic procedure codes for tracking and billing purposes.)

1. Cataract surgery

Cataract surgery is a common surgery procedure designed to correct blurry vision and reduce glare from lights. During the procedure, an ophthalmologist removes the lens of your eye and replaces it with an artificial lens.

How much does cataract surgery cost?

According to Medicare’s tool, the average out-of-pocket cost of cataract surgery is between $51 and $101 for CPT 66821, but the treatment may involve more than one procedure so the final cost could be more. And there may be additional costs from the facility where the procedure is performed.

Who typically needs cataract surgery?

The need for cataract surgery increases with age. In fact, one in five people ages 65 and up need the procedure, and that ratio increases to three in five people by age 80.

Not everyone with cataracts will need surgery to correct the problem, though. Only those having trouble doing everyday activities because of their cloudy, blurred vision will need the surgery.

Is cataract surgery covered by Medicare?

Yes.

2. Upper GI endoscopy

An upper GI endoscopy involves inserting a small camera into the esophagus, so your doctor can see the inside of your stomach and small intestine. This procedure is often performed to diagnose the cause of persistent heartburn.

If abnormalities are found, additional procedures may be performed at that time or scheduled for a later date.

How much does an upper GI endoscopy cost?

The average cost to the patient for this procedure is between $57 and $112 for CPT 50572, depending on the type of facility used.

Who typically needs an upper GI endoscopy?

People who suffer from acid reflux. Their symptoms often include abdominal pain, difficulty swallowing, nausea, or stomach bleeding.

Is an upper GI endoscopy covered by Medicare?

Yes.

3. Colonoscopy and biopsy

Like an endoscopy, a colonoscopy involves inserting a small camera attached to a tube into the intestinal tract — in this case into the colon. The main purpose of a colonoscopy is to check for colon cancer.

During this procedure, it’s not uncommon to find polyps, which are removed and sent for a biopsy. A biopsy is a lab test to determine whether tissue is cancerous.

How much does a colonoscopy cost?

It can be tricky to calculate the cost of a colonoscopy because there are several variables involved. For example, there's no need for a biopsy if polyps aren't found. But if something else is found, like a tear in the lining of the colon, an on-the-spot procedure might be performed.

Generally, the patient cost for a colonoscopy with no complications is between $100 and $195 for CPT 45380. And there may be additional costs from the facility where the colonoscopy is performed.

Who typically needs a colonoscopy?

Colonoscopies are recommended for anyone with a family history of colon cancer or over the age of 50, making this one of the most common procedures for seniors.

Your doctor is likely to order a colonoscopy if you have such symptoms as:

  • Rectal bleeding
  • A change in bowel habits including constipation or diarrhea
  • Narrow or thin stools
  • Abdominal discomfort including gas pain and bloating
  • Chronic fatigue
  • Unexplained weight loss
  • Unexplained anemia

Is it covered by Medicare?

Yes.

4. Arthroplasty knee (knee replacement)

”Arthroplasty knee” is a fancy way of saying “knee replacement.” No matter the term you use, this procedure repairs worn knee sockets, which can include complete or partial knee replacement.

Two out of three seniors will need knee replacement surgery at some point, making this the most common medical procedure for those over 65.

How much does a knee replacement cost?

It can be difficult to estimate the exact cost in advance because the surgeon may not know exactly what's needed until taking a look inside the joint. The cost can also vary depending on whether the knee replacement is performed in a hospital or at an ambulatory surgical center.

In many instances, knee replacement procedures might cost less in a hospital setting. The costs for arthroplasty knee surgery range from $524 to $1,364 (CPT 29879) when performed as a hospital outpatient. But it may be higher if it's performed in a clinical setting. Look into costs associated with the facility where the knee replacement will be done.

That's because hospital outpatient departments must cap Original Medicare patient costs at $1,364.

Who typically needs knee replacement?

Osteoarthritis is the most common reason for knee replacements, but other factors may lead to the deterioration of the knee joints, including:

  • Rheumatoid arthritis
  • Gout
  • Knee injuries
  • Knee deformities
  • Hemophilia
  • Bone disorders

Is it covered by Medicare?

Yes.

5. Total or partial hip replacement

A hip replacement, also known as hip arthroplasty, is a surgical procedure in which a damaged hip joint is removed and replaced with an artificial joint, often made of titanium and ceramic. During the procedure, the entire hip joint is surgically opened to remove the damaged head of a thigh bone and replace it with man-made materials, which eventually fuses with the bone. At the same time, the eroded lining of the hip socket is also removed and replaced, restoring mobility and resulting in pain-free movement.

Hip replacements are typically caused by osteoarthritis, a degenerative condition that erodes the surface of a joint. More than 10 million American seniors suffer from osteoarthritis.

How much does a total or partial hip replacement cost?

As with any medical procedure, pricing varies by your location and provider. On average, the patient's cost of a total hip replacement ranges from $548 to $1,139 for CPT 29862.

But remember: If a surgery like this is performed in a clinic setting, the Original Medicare cap of $1,364 doesn’t apply — which could increase the cost to you. Always look into costs associated with the facility where the hip replacement will be performed.

Who typically needs a hip replacement?

People over age 60 with osteoarthritis or other degenerative joint conditions of the hip.

Is it covered by Medicare?

Yes. Both partial and full hip replacement surgery is covered under Medicare.

Don't get surprised by medical procedure costs

Remember: Though the projected costs of these common medical procedures may help you prepare your wallet for the given procedure, they're just ballpark figures. Procedure costs can vary by your location, so it's always wise to check with your Medicare provider to get additional procedure cost estimates.

It's also worth noting that your doctor may order tests or additional procedures that may not be covered by Medicare. And if your procedure requires a hospital stay, there are plenty of ways to avoid costly hospital bills.

Also keep in mind that you may need additional services after your procedure, such as physical therapy, so you may need to factor rehabilitative services into the equation.

Choosing a Medicare plan

Having a general idea how much common medical procedures cost is a good first step to be prepared for them. But choosing the optimal Medicare plan for you is also important because coverage for some procedures may depend on whether you have Original Medicare or Medicare Advantage.

Medicare Advantage and Medicare Supplement are two common ways to replace or supplement Original Medicare, but they serve different purposes:

  • Medicare Advantage plans also known as Part C usually cover Parts A, B, and D with one bundled insurance policy for all Medicare coverage.
  • Medicare supplement insurance is not comprehensive medical coverage. Instead, it provides extra coverage to help pay for some of the healthcare costs and services that Medicare doesn’t cover. These plans, also known as Medigap, can offer protection from large out-of-pocket medical costs that result from numerous doctor or hospital visits. Additionally, a standalone prescription drug plan must be purchased to get prescription drug coverage.

If you need help choosing the right Medicare plan for your specific medical needs, you can find and compare Medicare plans through our plan comparison tool or by contacting one of our licensed Medicare insurance agents.

We've also put together Medicare FAQs for more information.

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