According to the Office on Women’s Health, U.S. Department of Health and Human Services, 500,000 women get hysterectomies each year, making it the second most common surgery for women in the United States. While there are numerous factors that contribute to a physician’s decision to recommend a hysterectomy, the potential for surgery comes with a fair amount of stress. At a time when you should be focusing on your health, you shouldn’t have to worry about the potential for intimidating medical bills for your surgery, and post-op care. Understanding what a hysterectomy involves and how Medicare covers the costs can help you prepare for surgery.
What is a hysterectomy?
In short, a hysterectomy is the removal of a woman’s uterus. The procedure can vary depending on the reason for the surgery. For instance, a surgeon may only need to remove the upper part of the uterus, keeping the cervix in place, in a subtotal hysterectomy. A total hysterectomy, on the other hand, removes the entire uterus and cervix. When certain types of cancer are present, such as cervical cancer, a radical hysterectomy may be performed, removing the uterus, cervix, tissue on the sides of the uterus, and the top part of the vagina.
Determining the Need for a Hysterectomy
Any major surgery comes with risk, and a hysterectomy is no different, but there are certain conditions or diseases that may result in the need for a hysterectomy. As you consider a hysterectomy, you should note that Medicare will cover the cost of a second surgical opinion if you choose to get one.
You may need a hysterectomy due to:
- Uterine fibroids – Fibroids are non-cancerous growths on the uterine walls that can cause pain and heavy bleeding.
- Endometriosis – Tissue that normally lines the inside of the uterus grows on the outside of it on the ovaries causing pain and excessive bleeding.
- Uterine prolapse – The uterus slips down into the vagina, causing pelvic pressure and potential urinary and bowel issues.
- Adenomyosis – Tissue grows inside the walls of the uterus where it does not belong, thickening the uterine walls causing extreme pain and heavy bleeding.
- Cancer – A hysterectomy may be the best option for treatment of cancer or pre-cancer of the uterus, cervix, ovary or endometrium. According to The National Cancer Institute, treatment options can also include chemotherapy, radiation, and alternative therapies.
How is a hysterectomy performed?
The reason for your surgery and your medical history may contribute to how your surgeon performs the hysterectomy. Talk to your surgeon about your options:
- Abdominal (or “open surgery”) hysterectomy
- Vaginal hysterectomy
- Laparoscopic hysterectomy
- Robotic hysterectomy
The abdominal hysterectomy removes the uterus through an incision in your lower abdomen and is sometimes performed due to the large size of the uterus or the need to check other pelvic organs for signs of disease.
The vaginal hysterectomy involves removing the uterus through the vagina after it is detached from the ovaries, fallopian tubes, upper vagina, blood vessels and connective tissue.
A laparoscopic hysterectomy uses very small cuts to the abdomen or vagina to remove the uterus with the help of a laparoscope, a thin, lighted tool that a surgeon uses to view the pelvic organs.
A robotic hysterectomy is similar to the laparoscopic procedure, but uses a robotic arm to perform the surgery.
The recovery from an abdominal hysterectomy may take longer than the other minimally invasive procedures. You may be kept in the hospital for 1-2 days, but advanced procedures have increased the number of outpatient hysterectomies being performed. Talk to your doctor about your options.
How can Medicare help cover the costs of a hysterectomy?
A hysterectomy can be an inpatient or outpatient procedure, and costs can vary based on the type of surgery. Medicare will help cover medically necessary doctor services including outpatient services and some doctor services you get when you’re a hospital inpatient.
Costs of Inpatient Care Medicare Part A will help cover the cost of an inpatient hospital stay when you are formally admitted to a hospital. Medicare covers semi-private rooms, meals, general nursing, and drugs as part of your inpatient treatment, and other hospital services and supplies. You’ll pay a deductible but no coinsurance as long as you have not been admitted to the hospital for the past 60 consecutive days.
Costs of Outpatient Care Medicare Part B will help cover hospital outpatient care. Generally, you pay 20% of the Medicare-approved amount for the doctor’s or other health care provider’s services in a hospital outpatient department. You generally pay the hospital a copayment for each service you get in a hospital outpatient setting. The Part B deductible applies, and you pay all costs for items or services that Medicare doesn’t cover.
The copayment for a single outpatient hospital service cannot exceed the inpatient hospital deductible. However, your total copayment for all outpatient services may be more than the inpatient hospital deductible. Your Medicare Advantage plan must cover at least the same benefits as Part A and Part B, but may offer additional coverage. Check your plan details for more information.