An Abdominal Aortic Aneurysm (AAA) is a bulging or swelling in the lower part of the aorta, the body’s main artery. An untreated AAA can rupture, leading to severe internal bleeding and a high risk of death. Due to the serious nature of this condition, Medicare generally covers medically necessary treatment, including preventative screening and surgical repair.
Coverage for Abdominal Aortic Aneurysm Screening
Medicare Part B covers a one-time preventative screening for an Abdominal Aortic Aneurysm using an ultrasound. This service is specifically designed for beneficiaries considered to be at risk for developing an AAA. The ultrasound is a non-invasive procedure that uses sound waves to check for abnormal swelling.
Eligibility for this single screening benefit is limited to individuals who meet specific risk criteria and receive a referral from their healthcare provider. A beneficiary is considered at risk if they have a family history of AAA. They also qualify if they are a male between the ages of 65 and 75 who has smoked at least 100 cigarettes in their lifetime. If the provider accepts Medicare assignment, the screening is covered at 100% of the Medicare-approved amount.
This preventative screening is a benefit that is offered once in a person’s lifetime. If a beneficiary is eligible, they typically pay nothing for the ultrasound itself. If a screening is ordered as a diagnostic test due to symptoms rather than a preventative measure, standard Medicare Part B cost-sharing rules generally apply.
Coverage for the Surgical Procedure
Medicare covers the surgical repair of an AAA when a physician deems the procedure medically necessary. The two primary methods for repair are traditional Open Surgical Repair (OSR) and the less-invasive Endovascular Aneurysm Repair (EVAR). Both procedures are covered by Medicare.
The facility and inpatient costs associated with the surgery are covered under Medicare Part A, which acts as Hospital Insurance. This coverage includes the costs for the semi-private room, operating room use, general nursing care, and hospital supplies used during the inpatient stay. Part A coverage is activated when the patient is formally admitted to the hospital.
Medicare Part B covers the professional services rendered by the medical team, acting as Medical Insurance. This includes the fees for the vascular surgeon, assistant surgeons, and the anesthesiologist. Part B also covers diagnostic tests performed outside of the inpatient stay and durable medical equipment needed after discharge.
For endovascular repair, which involves threading a stent-graft through blood vessels to reinforce the aorta, the specialized graft device itself is typically covered as part of the total procedure cost. EVAR often results in lower short-term mortality and morbidity compared to open repair. The choice of procedure depends on the specific anatomical characteristics of the aneurysm and the patient’s overall health.
Beneficiary Financial Responsibility
While Medicare covers the majority of costs for AAA surgery, beneficiaries are responsible for certain out-of-pocket expenses under Original Medicare (Parts A and B). For the inpatient hospital stay covered by Part A, the beneficiary must pay a deductible per benefit period. In 2024, this inpatient hospital deductible is \$1,632 per benefit period.
If the hospital stay extends beyond 60 days in a benefit period, the beneficiary is responsible for a daily coinsurance payment. For days 61 through 90, the coinsurance amount is \$408 per day in 2024. Beyond 90 days, the patient begins using their lifetime reserve days, which require a higher daily coinsurance.
For services covered under Part B, such as physician fees and diagnostic tests, the beneficiary must first satisfy an annual deductible, which is \$240 in 2024. After the deductible is met, the beneficiary is responsible for a 20% coinsurance of the Medicare-approved amount for most Part B services. This 20% share applies to the surgeon’s fees and any follow-up care.
Many beneficiaries purchase supplemental insurance, such as a Medigap policy, to help cover these cost-sharing obligations. Medigap plans can significantly reduce or eliminate the Part A deductible and the 20% Part B coinsurance. Alternatively, beneficiaries enrolled in a Medicare Advantage (Part C) plan receive their Part A and Part B benefits through a private insurer. These plans often have their own structure of co-pays and deductibles, which may differ from the Original Medicare cost structure.