HealthInsurance.com by TogetherHealth logo
Find a Medicare plan
Get Started →
Learning Center > 5 Common Medical Procedures for Seniors

5 Common Medical Procedures for Seniors

5 Common Medical Procedures for Seniors

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, however, Medicare only covers medical procedures when they are medically necessary. A doctor will determine the medical necessity of surgery for your cataract issues based on how badly your vision is impaired. Learn more about Medicare coverage for cataracts here.

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. If you have Original Medicare, endoscopies are covered under Medicare Part B.

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 depending on the state 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

Does Medicare Cover Colonoscopies?

Yes. Medicare Part B will cover a colonoscopy regularly, depending on your needs and risk factors. If you’re considered at high risk for colon cancer, Medicare will cover the exam every two years. Learn more about Medicare and colonoscopies here.

4. Does Medicare Cover 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.

What Other Conditions and Procedures are Covered by Medicare?

We've written several articles that discuss Medicare coverage and what conditions or procedures would or wouldn't be covered, including:

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 compare Medicare plans through our online Medicare plan finder or by calling 800-620-4519 to reach one of our licensedd insurance agents.

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

What you should read next

For many seniors, having a walk-in tub can be very helpful. When you have limited mobility, getting in or out of a traditional tub can be very difficult. If you have Medicare for your health insurance coverage, you might wonder, “Can a walk-in tub be covered by Medicare?” This guide will help you understand if this type of tub is considered durable medical equipment and eligible for coverage. Let’s get started! Does Medicare cover walk-in tubs? Does Medicare cover the cost of a walk-in tub? Original Medicare covers specific types of durable medical equipment (DME) as long as you get the equipment from a DME provider that accepts assignment from Medicare.  Durable Medical Equipment must meet the following requirements: Can be used repeatedlyIs used only for a medical reasonIs used in the patient’s homeIs expected to last 3 years or longerIs not useful to people who are not sick or injuredUnfortunately, a walk-in tub is not considered DME by Original Medicare. However, if you have a Medicare Advantage plan, you may be able to get coverage for a walk-in tub using that plan if your doctor prescribes it.How much are walk-in tubs for the elderly?Walk-in tubs can be quite expensive. For a basic model, you could pay between $2,000 and $3,000. Wheelchair-accessible tubs are more than twice as expensive, with prices between $5,000 and $10,000. There’s also the cost of installation to consider, which can vary significantly based on where you live, your bathroom layout, and what types of plumbing, tile work, and other changes need to be made.Getting a walk-in tub is a significant investment, which is why so many seniors would like to have help from Medicare in paying for it.How to get Medicare to pay for a walk-in tubWhile you won’t be able to get Original Medicare to pay for a walk-in tub, you might have better luck with a Medicare Advantage plan. These plans can offer additional benefits above and beyond what Original Medicare provides.Before you choose a Medicare Advantage plan, make sure it fits your needs. For example, they often have specific medical provider networks, and you’ll want to ensure that your preferred doctors and specialists are included. You also want to compare monthly premiums, deductibles, and copayments when you are deciding between plans.A walk-in tub can help you significantly if you have mobility issues, but there are other options that are less expensive. For example, you might look to installing grab bars in your bathroom to help you balance. These can cost as little as $75, up to $200 or so.Keep in mind that Original Medicare doesn’t cover these items, but a Medicare Advantage plan might. This could provide savings to you not just in terms of the walk-in shower, if covered by the plan, but with your overall Medicare costs.  Contact us to learn more about Medicare and walk-in tubsIf you have questions about other aspects of your Medicare coverage, we’re here to help. When you’re comparing Medicare plans and trying to choose the right option for your needs, talking to a licensed agent can help put your mind at ease.Contact us today to compare plans or ask questions about your Medicare coverage!
Read More
The Medicare Annual Enrollment Period (AEP), sometimes called Medicare Annual Open Enrollment or the Medicare Annual Election Period, runs from October 15 to December 7 each year. This is the time period in which Medicare beneficiaries can make certain changes to their Medicare plans, which we will cover below. Those plan changes would then become effective on January 1. But if Medicare beneficiaries are satisfied with their current Medicare plans, they don't have to take any action during Medicare AEP and there are no penalties involved. Medicare plan details can change annually, though, so it's wise to review your Medicare coverage each year. Overview of Medicare Enrollment Periods It's important to know that the Medicare Annual Enrollment Period is different from other Medicare enrollment periods. Here’s a quick overview of the differences: Annual Enrollment Period (AEP): Any changes to Medicare or Medicare Advantage plans Initial Enrollment Period (IEP): Only happens around your 65th birthday, any changes to Medicare or Medicare Advantage plansOpen Enrollment Period (OEP): Applies only to those with Medicare Advantage, who can change Medicare Advantage plans or drop them and return to Original MedicareGeneral Enrollment Period (GEP): Open enrollment period to join Medicare Part A and B.Special Enrollment Period (SEP): Occurs if you have eligible life changes that mean you need to change your plan before the next annual enrollment period.Be sure to visit our guide to different enrollment periods to learn more.What’s the Difference Between Medicare AEP and the Medicare General Enrollment Period?The Medicare Annual Enrollment Period is sometimes confused with the Medicare General Enrollment period, which is January 1 to March 31 each year. It’s important to understand the differences between the two enrollment periods.The Medicare General Enrollment Period is for Medicare beneficiaries who didn’t sign up for Medicare Part A) or Part B when they first became eligible and aren’t eligible for a Medicare Part B special enrollment period. The AEP, however, is for beneficiaries who are already enrolled in Medicare and want to change their Medicare coverage.What Changes Can I Make During the Medicare Annual Enrollment Period?The first thing to know is that you cannot use the Medicare Annual Election Period to enroll in Medicare Part A or Part B for the first time.If you’re enrolled in Medicare Part A and Part B and you’d like to change your Medicare coverage, here are some things you can do during the Medicare AEP:Change Medicare Advantage plans.Change Prescription Drug (Part D) plans. Enroll in a Prescription Drug Plan.Cancel your Prescription Drug Plan.Switch from Original Medicare to a Medicare Advantage plan.Switch from a Medicare Advantage plan back to Original Medicare (and add a Part D plan or Medicare Supplement plan if needed). 5 Tips to Prepare for the Medicare Annual Enrollment PeriodThere are many Medicare insurance carriers and plan options, but there are several steps you can take to be a savvy shopper and choose the right plan for your unique needs.1. Mark Your CalendarThis may seem like an obvious tip, but it’s worth mentioning: Mark your calendar for October 15 through December 7 if you’d like to make a change to your Medicare plan.You might even set aside a few hours to research and compare Medicare Advantage plans and Prescription Drug plans ahead of October 15. These plans announce their benefits for the next year starting on October 1.Writing down these Medicare AEP dates and to-dos will help you to commit to these priorities.2. Review Your Medicare Annual Notice of ChangeYou’ll receive lots of information over the next month or so prior to and during AEP, so if you’re currently enrolled in a Medicare Advantage or Prescription Drug Plan, the Annual Notice of Change (ANOC) is one piece of mail you’ll want to read.Your Medicare plan will mail your Annual Notice of Change letter to you by September 30. The ANOC letter will inform you of most changes to your Medicare health plan, including coverage and benefits that will take effect on January 1 each year.Each year, your Medicare health plan sets the amounts it will charge you for premiums, deductibles and other services. Medicare doesn’t set these rates - but your insurance company does. With this in mind, the amounts you pay could change each year.While evaluating your current Medicare plan, you may want to ask yourself questions like:Did the plan cover the services I needed?Did I use out-of-network providers?Did I spend more out of pocket than I originally anticipated?Has something changed with my health (new diagnosis, new prescriptions, etc.)?The ANOC will also provide a side-by-side comparison of your current plan and next year’s plan benefits, costs and other changes (if any).Moral of the story: Don’t toss this piece of mail aside. Always review your ANOC to ensure your plan continues to meet your needs on an annual basis. And if you don’t receive your ANOC by September 30, contact your Medicare insurance company.3. Make a List of What’s Important to Your HealthKeeping a list of what’s important to your health is an invaluable way to prepare for the Medicare Annual Enrollment Period.Start by writing down all of your doctors, preferred health care facilities and hospitals, and prescription drugs, if you take any.We also recommend making a list of value-added benefits that may fit your health, lifestyle and budget.For example, you may be someone who likes to keep active and have social interaction. So a fitness program like SilverSneakers, which gives you access to a network of gyms and other programs, might be a good fit for you. A Medicare Advantage plan may provide these types of fitness or wellness programs.Another thing to consider is whether or not you have an elective surgery planned for 2023. If so, you’ll want to check your hospital-specific benefits under your current Medicare Advantage plan.4. Check Your Plan’s Drug FormularyYour Medicare plan’s drug formulary will not be included in your Annual Notice of Change, so be sure you call your insurance carrier to see if your prescription drugs will be covered for the 2023 plan year.If your prescription drugs aren’t covered, it’s wise to use the Medicare Annual Enrollment Period to find a plan that does cover them.5. Talk To Your DoctorAnother “Medicare must-do” is to make sure all of your doctors and healthcare facilities will remain in network with your current Medicare plan. If they aren’t, you may want to take advantage of the Medicare Annual Enrollment Period.So be sure to ask your doctor if he or she plans on changing health plan affiliations over the next year.What Changes Can I Make During the Medicare Annual Enrollment Period?The first thing to know is that you cannot use the Medicare Annual Election Period to enroll in Medicare Part A or Part B for the first time.But if you’re enrolled in Medicare Part A and Part B and you’d like to change your Medicare coverage, here are some things you can do during the Medicare Annual Election Period:Change from Original Medicare to a Medicare Advantage plan.Change from one Medicare Advantage plan to another.Disenroll from your Medicare Advantage plan and go back to Original Medicare.Change from one prescription drug plan (Medicare Part D) to another.Enroll in a prescription drug plan.Cancel your prescription drug coverage.What Are The Benefits of a Medicare Advantage Plan?Understanding your Medicare plan options - starting with a Medicare Advantage plan - is a smart first step to take because you can switch, enroll into or disenroll from Medicare Advantage plans during AEP.Medicare Advantage plans, otherwise known as “Medicare Part C” or “MA Plans,” bundle Original Medicare (Parts A and B) services into one plan. These plans are offered by private insurance companies. And while Original Medicare offers you a number of benefits, it may not cover health and medical services you might need.Medicare Advantage plans are appealing to many people because they’re considered “all-in-one” plans that give you an annual cap on your spending as well as access to extra benefits, which may include: Dental and vision coveragePrescription drug coverageAccess to fitness programsHealth incentive programsRides to medical appointmentsTelemedicine servicesNote: If you have limited income, you might also qualify for extra savings on Medicare costs through these programs.Medicare Savings Programs. These programs help pay for some of your Medicare Part A and Part B out-of-pocket costs, such as copays, deductibles and premiums. Most programs are for Medicare beneficiaries who also qualify for Medicaid. And as mentioned, Medicaid covers the majority of your costs when you join a Medicare Advantage Special Needs Plan. You can check if you qualify through your local Medicaid office.Medicare Extra Help. Extra Help reduces your Medicare prescription drug plan costs. You should contact Social Security to check your eligibility for Extra Help if you have an existing Medicare drug plan or you join one during AEP.How To Enroll During the Medicare Annual Enrollment PeriodTo enroll in an eligible plan during the Medicare Annual Enrollment Period, you can visit our comparison tool. Or, you call (855) 651-5094 to talk to a licensed insurance agent to get help enrolling in Medicare.Whatever option you choose, be sure to have 3 items handy before you enroll in a plan or make changes to your current plan during AEP:Your Medicare number, which is found on your red, white and blue ID card.Your list of prescription drugs and preferred pharmacy.Your list of preferred doctors and hospitals.How To Find A Medicare Advantage or Prescription Drug Plan During AEPYou don’t have to go it alone when choosing a Medicare Advantage plan or Prescription Drug Plan. We’re here to help you navigate the Medicare Annual Enrollment Period through a number of ways, including:Our licensed agents: 1-800-620-4519Our Medicare plan comparison toolOur online Medicare resourcesView Our Medicare Annual Enrollment Period GuideThe experts at TogetherHealth have developed a Guide to the Annual Enrollment Period to help you prepare and make an informed choice for your healthcare needs during AEP each year.
Read More
You might remember when the price tag of the EpiPen made headlines in 2016. The cost of this life-saving medication, used to treat severe allergic reactions, went from $93.88 to $608.61 in a seven-year timeframe - a 500% price increase by drug manufacturer Mylan Pharmaceuticals. While the EpiPen story was an extreme case, it's not uncommon for prescription drugs to increase in price and become unaffordable. That's why you want to make sure you're paying the best price for your prescriptions.  Here are 6 tips to save money on prescription drugs & be a savvy shopper. #1. Buy Generic Brands This may be a no-brainer for some, but it's a cost-saving tip worth remembering. Generic drugs can be significantly cheaper than brand-name versions. While everyone benefits from generic drug prices, people over age 65, especially, saved $75 billion in 2016 by choosing generic drugs. It's important to know that you're not compromising the quality of the drug if you choose a generic brand: The FDA says that generic drugs have the same active ingredients and effectiveness of brand-name drugs - a part of the FDA's approval process. So if your doctor prescribes a brand-name drug, ask if there's a generic equivalent. The savings are worth the effort. #2. Join Rewards ProgramsCertain stores or pharmacies may offer coupons or rewards programs. Every rewards program is different, but in general: You can join a store's program (sometimes for free or for a small monthly payment) and earn points based on purchases. You can then use those points towards in-store purchases.You might also receive other perks like free 1 – 2 day shipping for prescriptions, 24/7 pharmacy consultations, or points for reporting wellness activities like walking or running. There are many reward programs to choose from - CVS ExtraCare Pharmacy & Health Rewards, Meijer mPerks, and Rite Aid wellness+ rewards are just three examples.#3. See If Your Drugs Qualify for Home DeliveryYou might save money if you get your prescription drugs shipped directly to your home. In some cases, you can order a 60- to 90-day supply for a better price than buying the drug in person at your local pharmacy. Prescription home delivery also makes sense if you're unable to drive or want the convenience of not having to travel to the pharmacy to pick up medications. Just be sure to check with both your doctor and your insurance company to make sure the home delivery option is available for your specific prescription drug.#4. Get A Prescription Savings CardPrescription savings cards provide discounts or coupons for medications at thousands of retailers nationwide. Many companies such as GoodRx and WellRx now offer them. Some even allow you to use them for pet prescriptions. Prescription savings cards typically show you where a drug is available and what the prices are at certain pharmacies.Simvastatin is a popular drug used to lower cholesterol and reduce the risk of stroke or heart attack. The average retail price of Simvastatin is around $66.39, but it can be as low as $4.00 prescription savings card. Prescription savings cards are suitable for almost everyone. However, it's important to check out the fine print to see what's covered.#5. Apply For Extra HelpYou may qualify to get help paying for your Medicare Prescription Drug Plan monthly premiums, annual deductibles and copayments through the Extra Help program.#6. Know Your Coverage OptionsIf you're enrolled in Original Medicare (Part A & B) and need prescription drug coverage, you have to sign up for a Medicare Prescription Drug Plan (Part D) or a Medicare Advantage (Part C) plan, but you can't have both. Call us today to compare plans and see if you qualify: 1-800-620-4519. This article is for general education purposes and does not replace the advice of a medical professional. Always seek the guidance of your physician or a medical professional for medical advice, diagnosis, and treatment. Outside of the Medicare Annual Enrollment Period, you can only enroll in a Medicare Advantage or Medicare Part D plan if you meet certain criteria.
Read More
(800) 596-1715 (TTY 711)
Talk to a licensed insurance agent
Mon.-Fri. 8am - 8pm ET
Privacy PolicyTerms of UseCalifornia Privacy NoticeDo Not Sell My InfoInterpreter ServicesNotice of Nondiscrimination
GENERAL DISCLAIMERS
This site is not maintained by or affiliated with the federal government’s Medicare.gov, Health Insurance Marketplace website or any State government health insurance marketplace.
HealthInsurance.com LLC is a commercial site designed for the solicitation of insurance from selected health insurance carriers. It is not an insurer, an insurance agency, or a medical provider. Insurance agency services may be provided by one of our sister companies, including TogetherHealth PAP, LLC, Health Plan Intermediaries Holdings, LLC, Total Insurance Brokers, LLC, or HealthPocket d/b/a AgileHealthInsurance Agency, which are all part of the Benefytt Technologies, Inc. family of companies.
If you provide your contact information to us, an insurance agent/producer or insurance company may contact you to provide more information about your Medicare insurance plan options, as well as offer information to help you enroll in a Medicare Advantage and/or Prescription Drug plans available from one of the Medicare-contracted carrier(s) we represent.
Alternatively, you may be referred, via a link, to a selected partner website, which is independently owned and operated and may have different privacy and terms of use policies from us.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-Medicare (24 hours a day/7 days a week) to get information on all your options.
If you do not speak English, language assistance service, free of charge, is available to you. Contact our toll-free number listed at the top of this page.
MULTIPLAN_TGHBFYTQEN_2022
© 2021 HealthInsurance.com LLC