Original Medicare, and some Medicare Advantage plans, cover hernia surgery when it is medically necessary. Similar to other types of surgery, different parts of Medicare may cover certain aspects of care.
The care related to hernia surgery may vary depending on the procedure, the surgical setting, and any complications that develop.
This article describes hernias and hernia surgery, and looks at Medicare coverage, costs, and possible financial assistance.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
A hernia involves a weakness in the muscular tissue that holds an organ in place. The weakness causes the organ to bulge, which creates a lump under the skin. In many cases, a hernia involves the abdominal wall.
Activities and factors that place pressure on the abdominal wall, and therefore increase a person’s risk of a hernia, may include:
- chronic straining, such as coughing and constipation
- strenuous activities that cause straining, such as weightlifting
- being overweight
- cystic fibrosis
- enlarged prostate
- peritoneal dialysis
- poor nutrition
Types of hernia
There are several types of hernia, with the most common being an inguinal hernia, which involves the lower abdominal wall in the groin area. It is more common in men than in women.
Other types of hernia include:
- Incisional hernia: A person who had abdominal surgery may get this type of hernia.
- Femoral hernia: This bulge can appear in the upper part of a person’s thigh, and is less common in men.
- Hiatal hernia: This hernia is seen in the upper part of the stomach.
- Umbilical hernia: If the muscle around a person’s belly button does not close after birth, it can result in this type of hernia.
Some people may not have hernia symptoms, and the bulge may be painless and only appears when a person coughs or strains. However, where there are hernia symptoms, they may include:
- increased pain at the lump
- pain when lifting
- increase in the size of the bulge
- aching at the bulge
Hernia surgery involves repairing the weakness in the muscular tissue. The procedure may depend on the type and size of the hernia.
The two main procedures for hernia surgery include open surgery and laparoscopic repair.
During an open hernia surgery, the surgeon makes a cut over the hernia and places the protruding organ back in place. The surgeon may also put mesh in the abdominal wall to strengthen the area and then close the cut with surgical glue, staples, or stitches.
A laparoscopic repair surgery,