Does Medicare Cover a Hysterectomy?
Medicare will cover a hysterectomy if it’s considered medically necessary by your doctor. Elective hysterectomies performed only to prevent future pregnancy are not covered. Speak with your doctor or Medicare plan provider to estimate how much your surgery may cost.
What Is a Hysterectomy?
A hysterectomy is a surgical procedure that removes the uterus, and in some cases, the ovaries and fallopian tubes.
In a total hysterectomy, the entire uterus — including the cervix — is removed. In contrast, a supracervical or partial hysterectomy removes the upper part of the uterus, but the cervix is left in place.
A hysterectomy that includes the removal of one or both ovaries and fallopian tubes is called a total hysterectomy with salpingo-oophorectomy.
Hysterectomies can be performed in several ways.
- The uterus is removed through the vagina.
- The uterus is removed through an incision in the lower abdomen.
- Laparoscopic or Robotic Assistance
- A thin, lighted tube — known as a laparoscope — is inserted into the abdomen through a small incision in or around the navel. The scope has a small camera that projects images onto a monitor. Additional small incisions are made in the abdomen for other instruments used during the surgery.
Hysterectomies are performed for a variety of reasons. Some women undergo a hysterectomy to prevent future pregnancy while others do so to treat an illness or disease.
- Gynecologic Cancer
- This includes cancer of the uterus or cervix. Depending on the type of cancer you have, other options may include radiation or chemotherapy.
- These are benign uterine tumors that often cause persistent bleeding, anemia, pelvic pain or bladder pressure.
- In endometriosis, the tissue lining your uterus grows outside the uterus on your ovaries, fallopian tubes, or other pelvic or abdominal organs.
- Uterine Prolapse
- Descent of the uterus into your vagina can happen when supporting muscles and tissues weaken. Uterine prolapse can lead to urinary issues, pelvic pressure or difficulty with bowel movements.
- Abnormal Vaginal Bleeding
- A hysterectomy may bring relief if your periods are heavy, irregular or prolonged.
- Chronic Pelvic Pain
- Occasionally, surgery is necessary for women who experience chronic pelvic pain in the uterus.
According to researchers at Columbia University, hysterectomies are one of the most common surgical procedures among women.
Estimates suggest that 1 in 9 women will undergo a hysterectomy during their lifetime and approximately 600,000 procedures are performed in the U.S. each year.
When Does Medicare Cover Hysterectomy Surgery?
Medicare will only cover a hysterectomy or other sterilization surgery when it is deemed necessary to treat an illness or injury — such as removal of the uterus because of a tumor or the removal of diseased ovaries.
A doctor must determine that the procedure is medically necessary.
According to the National Women’s Health Network, some examples of medically necessary hysterectomies include unmanageable infection, unmanageable bleeding or cancer of the uterus, cervix, vagina, fallopian tubes or ovaries.
Benefits also cover lab work, office visits and diagnostic testing.
Medicare will not cover elective hysterectomies, tubal ligation or vasectomies if the primary goal of these procedures is sterilization.
This is true even if a physician believes another pregnancy would endanger the overall general health of the women.
Medicare Advantage Plans
The Centers for Medicare & Medicaid Services has not released a specific National Coverage Determination for hysterectomy procedures performed for benign conditions.
Medicare Advantage plans can create their own coverage determinations in these situations.
Medicare Advantage, or Part C, is a plan administered by a private insurer and must provide the same benefits as Original Medicare.
United HealthCare, which administered 26 percent of all Medicare Advantage plans in 2020, provides guidance on situations when a hysterectomy may be covered for a benign condition.
This can include uterine fibroids, endometriosis, pelvic organ prolapse and abnormal uterine bleeding.
To see if a hysterectomy is covered for your treatment or condition, speak with your doctor and Medicare plan provider.
How Much Does a Hysterectomy Cost with Medicare?
It can be difficult to know the exact cost of a surgery or procedure in advance.
However, there are a few costs to expect.
After meeting your deductibles, Medicare pays 80 percent of all approved costs. You’ll be responsible for the other 20 percent if you don’t have any supplemental insurance, such as Medigap or Medicaid.
- Ask your doctor, hospital or medical facility staff how much you'll need to pay for the operation and any care you may require afterward.
- Find out if you're an inpatient or outpatient. This can impact how much you pay.
- Check with any other insurance you may have to see what’s covered. If you’re a Medicare Advantage beneficiary, contact your plan for more information.
8 Cited Research Articles
- Freed, M., Damico, A. & Neuman, T. (2021, January 13). A Dozen Facts About Medicare Advantage in 2020. Retrieved from https://www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage-in-2020/
- United HealthCare. (2021, January 1). Hysterectomy for Benign Conditions. Retrieved from https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/hysterectomy-benign-conditions.pdf
- Mayo Clinic. (2019, July 25). Abdominal hysterectomy. Retrieved from https://www.mayoclinic.org/tests-procedures/abdominal-hysterectomy/about/pac-20384559
- U.S. Department of Health and Human Services. (2019, April 1). Hysterectomy. Retrieved from https://www.womenshealth.gov/a-z-topics/hysterectomy
- National Women’s Health Network. (2015, July 9). Hysterectomy. Retrieved from https://nwhn.org/hysterectomy/
- Wright J. et al. (2013). Nationwide trends in the performance of inpatient hysterectomy in the United States. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3913114/#R1
- Centers for Medicare & Medicaid Services. (n.d.). National Coverage Determination (NCD) for Sterilization (230.3). Retrieved from https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=13&ncdver=1&bc=AAAAgAA
- Medicare.gov. (n.d.). Surgery. Retrieved from https://www.medicare.gov/coverage/surgery