Does Medicaid Cover Hernia Surgery?

Hernia surgery is a strong medical procedure that Medicaid partly covers. Unfortunately, the amount cover for this case is less than half compared to Medicare.

For example, according to Reuters’ report in 2016, to perform a ventral hernia surgery, the Medicaid branch in New Hampshire gives $300 for assistance; that is 61% percent less than the $762.28 Medicare coverage in the same state.

With this in mind, if you want to know more about the conditions to cover a hernia surgery, we have compiled all the main points you should know in this article.

What is Hernia Surgery?

Before we start talking about coverage, let’s understand more about this procedure. Hernia surgery aims to restore the sickness inside the hip’s tendon. The treatment may be different based on the extent and type of the hernia.

The main forms of hernia surgeries are open surgery and laparoscopic.

doctors performing a surgery

  • When doing an open hernia surgery, as the name suggests, the surgeon opens the body and removes the part of the organ that is protruding and causing pain. A mesh is commonly used to support the abdomen’s wall and later cover the wound with surgical sutures, staples, or stitches.
  • On the other hand, laparoscopic surgery is a minimally invasive type of surgery, which is performed by an incision on the skin. The surgery requires a tiny incision on the abdomen to examine the abdomen with a monitor and light inserted into one of the incisions. 

The surgeon fixes the hysterectomy by putting surgical tools into a slight incision. In abdominal surgery, the belly is inflated with gas to aid the doctor in conducting their treatment.

What is Medicaid?

Medicaid is the US health assistance program for people with low or very low income. In most cases, people who receive this assistance do not have to pay anything of the medical expenses; but sometimes a small payment will be required depending on the procedure.

The eligibility is mainly based on income, but you need to make sure to fulfill the whole criteria; click here for more information.

According to a recent report, it costs much less for common medical operations than Medicare does. Many of the coverage cuts are so high that they can pose a major obstacle to receiving health insurance. State Medicaid investments constitute nearly half of the overall government funding.

Does Medicaid Cover Surgical Procedures?

When it comes to surgical treatments, both Medicare and Medicaid cover required surgical facilities. However, depending on the type of surgery done, the particular situation coverage can impact you.

Medicare and Medicaid have the right to decide what coverage is provided depending on the treatments. These operations can include admission to a hospital for one or more nights.

Knowing various forms of surgeries will help you decide whether the plans are under coverage.

Emergency Surgery

In some cases, surgeries are conducted to avoid life-threatening situations from an acute accident or sickness. The case can be from preexisting disorder.

Elective Surgery

The procedures offer therapies for symptoms that are not life-threatening but could also be required to regain function or increase the patient’s quality of life.

Cosmetic Surgery

It includes changing a patient’s appearance as a method of boosting self-esteem or meeting personal desires, but they may often enhance face skin due to injuries or personal reasons.

In any event, an emergency surgery always counts for Medicaid reimbursement. If surgical treatment is necessary to ensure wellbeing, it may also be covered. 

Each state’s department determines the guidelines for required treatment and varies from a physician’s defined medical need.

As Medicare covers much of the same surgeries as Medicaid, additional costs can become a financial burden for certain recipients. Those with reduced standards of eligibility earn lower levels of coverage that reduce their prices. 

For Medicaid beneficiaries, the government may offer both Part A and Part B premium support in addition to all co-payments, coinsurance, and deductibles. When a hospital stay for treatment extends Medicare Part A’s maximum coverage, the patient will be eligible for Medicaid coverage to cover other costs.

READ MORE: Can hospitals do surgery without insurance?

Does Medicaid Cover All Necessary Healthcare Facilities?

All States are expected to offer facilities that have been designated obligatory. However, some therapies and procedures are classified as voluntary. 

Discussing every treatment strategy through the healthcare team helps you consider your care costs and what Medicare and Medicaid can cover. This will help you prevent unforeseen expenses that you weren’t planning.