December 11th 2023
By Ari Parker
Find out if Medicare covers bunion surgery and what coverage options may be available to you. Learn all you need to know about Medicare coverage of bunion surgery.
Bunions are painful and can make it difficult to walk comfortably. These bony bumps develop when your big toe pushes against the next toe, which forces the joint of the big toe to become more pronounced. The area around this joint becomes inflamed, red, tender, and painful when a bunion forms. Oftentimes, bunions are caused by shoes that don’t fit properly, or by shoes with a small space for your toes (e.g., pointed-toe shoes). You can also be genetically predisposed to forming them as well.
If a bunion becomes severely inflamed and painful, you may need surgery (called a bunionectomy) to correct your toe positioning. Fortunately, Medicare covers the cost of bunion surgery if it is medically necessary.
Original Medicare and Medicare Advantage help pay for the cost of bunion surgery.
Medicare Part D helps cover the cost of prescription drugs following the procedure.
Yes, Medicare helps pay for bunion surgery. Without insurance, bunion surgery could cost anywhere between $3,500 to $12,000! We'll explain how Original Medicare and Medicare Advantage cover the cost of the procedure, so you understand what amount you might be responsible for with your Medicare insurance coverage.
On Original Medicare helps pay for any foot-related exams and treatment under two circumstances:
you have diabetes-related foot issues.
you need medically necessary procedures for foot-related problems. This includes issues like hammer toe, bunion deformities, and heel spurs.
Even for covered services, Original Medicare only pays for 20% of the cost once you’ve met your Part B deductible. So, you may be responsible for $700 to $2,400, depending on the total cost of your surgery. Because Original Medicare doesn’t pay for 100% of the cost of covered services, many Medicare beneficiaries choose to add a Medicare Supplement (aka Medigap) plan to their coverage. Medicare Supplement plans can help you significantly reduce your out-of-pocket costs by paying for deductibles, coinsurance, and copayments. As an example, with the most popular Medigap plan (Medigap Plan G), you wouldn’t owe anything for your bunion surgery once you’ve met your Part B deductible.
Medicare Advantage plans cover the same services as Original Medicare. For this reason bunion surgery is also covered by Medicare Advantage. Keep in mind that Medicare Advantage coverage varies from plan to plan and price structures may be different depending on the specific plan you have.
One more thing to consider is that you may need to get prior authorization with your Medicare Advantage carrier before getting the surgery to ensure your bunion surgery is covered.
With any surgery, you’ll need medications and follow-up care for surgery recovery. A Medicare Part D plan can cover prescription medications, including those following a surgery. Since coverage varies between plans, it’s important to check your drug plan’s list of covered drugs. If you’re unsure if one of your prescriptions is covered, consult your plan carrier to get an understanding of what you’ll pay for medications.
For Medicare to cover bunion surgery, the procedure needs to be medically necessary. Doctors will determine that someone qualifies for bunion surgery if:
They experience persistent pain while performing daily activities, even after trying other treatments such as changing footwear, physical therapy, and pain medications.
There is a severe deformity in the big toe joint.
X-rays indicate significant joint damage caused by the bunion.
Generally, bunion surgery is medically necessary if a bunion affects your quality of life and you’re unable to perform daily activities comfortably due to pain from the bunion.
Before getting bunion surgery, your doctor will perform X-rays to determine if you need the surgery, and the right type of surgery. To perform the surgery, your doctor will give you local anesthesia to numb your foot. From there, a surgeon will realign the bones of the big toe and adjust problems in soft tissue around the affected area. The length of the surgery depends on the severity of the bunion and how much damaged tissue exists.
Following the surgery your doctor will prescribe pain management medication, crutches, and/or a special shoe to walk in. Your doctor will also give you instructions for taking care of the wound and stitches and schedule a post-op appointment to make sure everything is healing properly. Recovery usually takes somewhere between six weeks and six months, depending on the extent of the surgery and how long you take to heal. Some people choose to go through physical therapy and rehabilitation, but it’s generally not needed.
Have questions about your Medicare coverage? Our Medicare Advisors and Advocates can help you understand what your Medicare insurance covers and what costs you can expect to pay. Schedule a free consultation or give us a call at (855)-900-2427 to get your Medicare questions answered!
