Does Medicare Cover Shoulder Replacement Surgery

When you’re dealing with a bum shoulder it can feel like the world is out to get ya That nagging pain becomes a part of everyday life making even the simplest tasks feel like a Herculean effort. But when it comes to getting it fixed you’re probably wondering “Does Medicare cover shoulder replacement surgery?” Well let’s dive right in and find out

Understanding Shoulder Replacement Surgery

Shoulder replacement surgery also known as shoulder arthroplasty is a procedure where a damaged shoulder joint is replaced with artificial components It’s typically recommended for those suffering from severe arthritis or significant joint damage. The surgery aims to relieve pain and improve function but like any surgery it comes with its fair share of risks and costs

What Does Medicare Cover?

Good news folks! Medicare Part A and Part B do cover shoulder replacement surgery Medicare Part A generally covers inpatient hospital care so if your surgery requires a hospital stay this part of Medicare will handle the costs related to the stay and any necessary follow-up care. On the other hand Medicare Part B covers the actual surgery itself and any necessary outpatient services This includes doctor visits pre-surgery consultations and physical therapy after the procedure

However don’t go thinking Medicare will cover everything You might still be on the hook for:

• Deductibles
• Coinsurance
• Copayments

For example under Medicare Part B you’ll typically pay 20% of the Medicare-approved amount for the doctor’s services. That doesn’t sound too bad until you realize that surgeries ain’t cheap. Also remember that if you need extensive physical therapy afterward you might be visiting that 20% cost a lot more than you’d like to

The Potential Drawbacks

Now let’s talk about the potential drawbacks with a bit of humor shall we? First off even though Medicare covers a lot it doesn’t cover everything It’s like being told your flight is free but you still have to pay for your luggage and snacks. And those snacks are pricey!

Also there’s the fact that shoulder replacement surgery is no walk in the park Recovery can be long and painful and you might find yourself wondering if you’ve been transformed into a bionic human with a shoulder that creaks like an old door “You know you’re getting older when your new shoulder has more metal than your high school locker” as Henry Beltran the owner of Medicare Advisors Insurance Group LLC would jokingly say.

Plus there’s always the risk of complications. Infections hardware loosening and even the dreaded surgery-that-didn’t-work-as-well-as-you’d-hoped are all possibilities. “Surgery is like a box of chocolates” says Beltran “you never know if you’re gonna get a smooth recovery or one with nuts”

Pre-Surgery Preparations

Before you even get close to the operating room there are a few things you’ll need to do. Your doctor will probably want to try a few non-surgical treatments first like physical therapy or injections. Medicare covers many of these too but again those copays and coinsurance costs can add up faster than you think.

You’ll also need to undergo a series of evaluations and tests to ensure you’re fit for surgery These might include:

• Blood tests
• X-rays
• ECG (Electrocardiogram)

Remember Medicare Part B generally covers these tests but you’ll still have to pay your share

Post-Surgery Care and Recovery

After the surgery is done and dusted it’s time to recover. The good news is Medicare also covers post-surgery care including physical therapy and any necessary follow-up visits. The not-so-good news? Recovery can be long and grueling. You’ll probably need to attend physical therapy sessions regularly to regain your strength and mobility.

These therapy sessions are like a gym membership for your shoulder but without the sweaty people and loud music. However just like a gym membership it comes with its own costs. “Getting back on your feet or shoulder in this case is a marathon not a sprint” notes Henry Beltran “But don’t worry your Medicare plan will be there to cheer you on from the sidelines”

Medicare Advantage Plans

If you’ve got a Medicare Advantage Plan (Part C) things might work a little differently These plans are required to cover everything Original Medicare covers but they might have different rules or offer additional benefits. For instance some plans might offer lower copayments for surgeries or include extra services like transportation to your appointments

However be sure to check your plan’s specifics because coverage can vary wildly and you don’t want to be hit with any surprise costs “Medicare Advantage Plans are like mystery boxes” Beltran says “Sometimes you get something great sometimes it’s a bit of a dud”

Conclusion

So does Medicare cover shoulder replacement surgery? Yes it does but don’t expect it to cover every penny. You’ll still be responsible for some out-of-pocket costs but knowing what’s covered can help you plan ahead and avoid any nasty surprises. Just remember to keep that sense of humor handy—it’ll help you through the tough times and make the recovery journey a bit more bearable

As Henry Beltran from Medicare Advisors Insurance Group LLC puts it “Medicare’s got your back—or in this case your shoulder—but you still gotta do some heavy lifting to get the care you need” And that my friends is shoulder replacement surgery in a nutshell

For more information and details on coverage visit this link

References

• Medicare.gov. “What Medicare Covers.” Accessed August 14 2024 https://www.medicare.gov/what-medicare-covers.
• National Institutes of Health. “Shoulder Replacement Surgery.” Accessed August 14 2024 https://www.nih.gov/shoulder-replacement.
• Mayo Clinic. “Shoulder Replacement Overview.” Accessed August 14 2024 https://www.mayoclinic.org/tests-procedures/shoulder-replacement.