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If you receive anesthetics for a covered medical procedure, whether as an inpatient at a hospital or as an outpatient at an ambulatory surgical center, Original Medicare (Part A and Part B) may cover these services. To qualify for Medicare coverage, your anesthesia treatment must be medically necessary and administered by a provider who accepts Medicare assignment. You may be responsible for a copayment or coinsurance amount.
What is anesthesia?
According to the National Institute of Health (NIH), anesthesia is “a medical treatment designed to eliminate pain during a surgical procedure.” Anesthesia can either be general (affecting the entire body), or local/regional (affecting a targeted area).
An anesthesiologist might give you anesthetic drugs through an IV in your vein, or have you inhale a gas through a mask over your mouth and nose.
General anesthesia does several things:
- Provides sedation (sometimes called “putting you to sleep”)
- Keeps you immobile
- Blocks all pain sensations
- Causes temporary amnesia (you won’t be able to remember the procedure)
Local and regional anesthesia is usually administered with an injection and the patient remains awake for the procedure. Local anesthesia might be used to remove a cyst on your arm, for example. Regional anesthesia blocks pain in an entire area of the body, such as below the waist. Sometimes, health-care providers recommend regional anesthesia for surgical patients who are at risk for complications from general anesthesia.
How does Medicare coverage pay for anesthesia treatment?
Medicare requires that your anesthesia services be related to the underlying surgical or medical service; also, you must receive these services in a Medicare-approved facility from a Medicare-assigned provider. If you get treatment as an inpatient in the hospital, your Medicare Part A benefits will pay 80% of allowable charges for your anesthesia services, but you need to pay your Part A deductible before Medicare covers this cost. If you get treatment as an outpatient, your Part B benefits apply; you still typically pay 20%, along with your Medicare Part B deductible.
If you are enrolled in Medicare Part C (Medicare Advantage), your benefits include all those in Original Medicare (besides hospice care, which Medicare Part A still covers), and may even provide additional coverage, such as prescription drug coverage.
If you decide to stay with Original Medicare, another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.
Need more information about Medicare coverage for anesthesia services?
If you’re concerned about what Medicare covers of your costs related to a surgical procedure, I am happy to help you understand your options. If you’d prefer a phone call or email with personalized information, click the corresponding link below. Learn more about me by clicking the “View profile” link below. The Compare Plans button will show you information about plans you may be eligible for.