Medicare covers bunion removal when your doctor finds it medically necessaryServices or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice. and prescribes surgery as the best treatment. However, prior to surgery, your doctor is likely to give you a prescription for bunion inserts, pads, or toe spacers.
Key Takeaways
- Bunions are painful protrusions that commonly form on the base of the big toe.
- Bunion surgery is a minor surgical procedure that can remove the bunion and correct the toe’s position.
- Medicare will cover bunion surgery if a doctor determines it is medically necessary to relieve pain.
- Medicare can provide coverage for therapeutic foot inserts for qualifying beneficiaries.
- While bunion surgery can cost $3,000 to $12,000, Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. will cover 80 percent of the costs for qualifying beneficiaries.
- Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plans will cover the beneficiary’s prescription drugs after bunion surgery.
- Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). will cover bunion surgeries, but the beneficiaryA person who has health care insurance through the Medicare or Medicaid programs. will have to use providers within the plan.
What Are Bunions?
A bunion is an abnormal bony protrusion on the base of your big toe joint caused by a displaced joint. This will shift the big toe and cause it to drift toward your second toe, which exacerbates the already miserable condition. This will cause painful swelling, nerve damage, and affect your mobility. Bunions can form due to:1mayoclinic.org, “Bunions“, Accessed November 10, 2021
- Wearing tight and improperly fitted shoes.
- The natural shape of the foot.
- A foot deformity.
- Medical conditions such as arthritis and diabetes
What Is Bunion Surgery?
Bunion surgery is just a minor invasive procedure to get rid of the bunion. The surgeon will numb the afflicted area for the procedure, remove any protruding bone and tissue, and realign the toe. They will even give you some sedatives so you can relax and read a book while the surgeon works. While a full recovery will take a few weeks, most patients will walk out of the clinic after bunion surgery.2healthpartners.com, “What is bunion removal surgery“, Accessed November 10, 2021
How Does Medicare Cover Bunion Surgery?
Medicare will cover bunion removal if a podiatrist, a doctor that specializes in foot care, finds it medically necessary and non-surgical treatments did not do anything for your foot. Most bunion surgeries are performed in an outpatient surgical center, which is covered by Medicare Part B.3Medicare.gov, “Foot care“, Accessed November 10, 2021
If a doctor deems bunion surgery as medically necessary during a beneficiary’s inpatient hospital stay, skilled nursing facility stay, home healthcare visit, or hospiceHospice is a special way of caring for people who are terminally ill. Hospice care involves a team-oriented approach that addresses the medical, physical, social, emotional, and spiritual needs of the patient. care, it would instead be covered by Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care..3Medicare.gov, “Foot care“, Accessed November 10, 2021
Foot Care Services
Medicare covers podiatry services for all your severe foot conditions, including bunions, hammer-toes, and heel spurs. However, Medicare won’t cover minor foot care such as the removal of calluses and corns, nail maintenance, or foot cleaning. That is the realm of pedicure salons.4Medicare.gov, “Therapeutic shoes & inserts“, Accessed November 10, 2021
Foot exams and services are covered if needed as part of a treatment for a chronic condition, such as diabetes. This includes custom-molded shoes and inserts for those with severe diabetic foot disease and orthopedic shoes if you have a leg brace.4Medicare.gov, “Therapeutic shoes & inserts“, Accessed November 10, 2021
How Much Does Bunion Surgery Cost?
The cost of bunion surgery can range from $3,500 to $12,000, depending on the area and the type of surgical technique(s) that are used2healthpartners.com, “What is bunion removal surgery“, Accessed November 10, 2021. If the bunion surgery was performed as an outpatient procedure, Medicare Part B will pay 80 percent of all approved costs once the beneficiary has paid their annual Part B deductible. If the surgeon, anesthesiologist, or the surgical center charge Part B Excess ChargesA Medicare Part B excess charge is the difference between a health care provider’s actual charge and Medicare’s approved amount for payment., the beneficiary is responsible for paying these costs.
In the rare situation that your bunion surgery is performed as an inpatient procedure, the hospital costs are covered by Medicare Part A, which has a benefit periodA benefit period is a method used in Original Medicare to measure a beneficiaries use of hospital and skilled nursing facility (SNF) services. With each new benefit period, the beneficiary is charged a new benefit... deductible. Hospital services related to inpatient surgery include things like daily room and board, laboratory services, diagnostic tests, surgical equipment and supplies, anesthesia, and the services of nurses, and other health professionals. The price can really add up when it comes to hospitals, so you’re much better off financially just getting the procedure done at an outpatient facility.
Post-Surgery Medication Costs
When post-surgery medication is required it will generally be covered by a beneficiary’s Medicare Part D plan. Depending on the Part D plan, members may pay an annual deductible, before the plan begins paying its share, as well as a copayment.5Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 10, 2021
Medicare Advantage
Since Medicare Advantage plans are required to cover the same services as Medicare Part A and Part B, it will also cover your bunion surgery. However, your out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. with a Medicare Advantage plan may be different than those with Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage., depending on the plan provider. You may also be restricted to using in-networkDoctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get... providers for all your services, supplies, and durable medical equipmentDurable medical equipment (DME) is equipment that is designed to last and can be used repeatedly. It is suitable for home use and includes wheelchairs, oxygen equipment, and hospital beds..6Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 10, 2021
Medigap
People with Original Medicare can purchase additional insurance, called MedigapMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage., to help cover their Medicare Part A and Part B out-of-pocket costs. Medicare supplement insurance, as it is also known, is available through private insurance companies. A Medigap policy will cover some or all of the out-of-pocket costs from bunion surgeries covered by Part A and Part B. These costs include:7Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed November 10, 2021
- DeductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share.
- CoinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service.
- CopaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service.
Summary
If you have a bunion and it is causing you pain, put on some comfy shoes and go consult with your doctor about surgical options. Bunion surgery could be the logical next step to relieve your foot pain. If you meet the eligibility conditions, and your doctor orders the procedure, Medicare will pay its share.
Citations
- 1mayoclinic.org, “Bunions“, Accessed November 10, 2021
- 2healthpartners.com, “What is bunion removal surgery“, Accessed November 10, 2021
- 3Medicare.gov, “Foot care“, Accessed November 10, 2021
- 4Medicare.gov, “Therapeutic shoes & inserts“, Accessed November 10, 2021
- 5Medicare.gov, “What Medicare Part D drug plans cover“, Accessed November 10, 2021
- 6Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 10, 2021
- 7Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed November 10, 2021