An abdominal aortic aneurysm (AAA) is a condition where a weakened section of the aorta, the body’s main artery, begins to bulge or swell. This ballooning can lead to a life-threatening rupture requiring immediate medical attention. Since repair is a medically necessary intervention, Medicare provides coverage for the surgical procedure. This coverage is structured across different parts of Medicare, covering everything from initial screening to the hospital stay and professional services.
Coverage for AAA Screening and Diagnosis
Medicare Part B covers a one-time ultrasound screening for AAA, provided specific eligibility requirements are met. This preventive service is covered at no cost if the provider accepts assignment. The screening must be ordered by a physician and is typically done during the “Welcome to Medicare” preventive visit.
Eligibility requires either a family history of AAA or being a man aged 65 to 75 who has smoked at least 100 cigarettes in their lifetime. If these risk factors are met, Medicare covers the abdominal ultrasound once. If an aneurysm is detected, subsequent diagnostic tests, such as follow-up ultrasounds or computed tomography (CT) scans for monitoring, fall under standard Part B coverage. These follow-up tests are subject to the Part B annual deductible and a 20% coinsurance.
How Medicare Covers the Surgical Procedure
Once the AAA is diagnosed and reaches a size requiring intervention, Medicare covers the repair. Coverage for the surgery is divided between Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). This dual structure ensures that both facility costs and professional fees are addressed.
Medicare Part A covers the inpatient hospitalization, including facility fees, operating room usage, necessary medications administered during the stay, and general nursing care. This coverage applies to both major procedural approaches: traditional open surgical repair and the less invasive Endovascular Aneurysm Repair (EVAR). Part A coverage remains the same regardless of the length of stay or type of surgery, provided the patient is formally admitted as an inpatient.
Medicare Part B covers the professional medical services provided during the surgery. This includes the fees for the vascular surgeon who performs the repair, the anesthesiologist’s services, and any other physicians involved in the procedure. Part B also covers certain outpatient services and durable medical equipment needed after discharge.
Understanding Patient Out-of-Pocket Costs
Even with Medicare coverage, beneficiaries are responsible for certain out-of-pocket expenses related to AAA surgery. These costs are determined by the deductibles and coinsurance obligations of Original Medicare Parts A and B. For 2025, the Part A inpatient hospital deductible is \\(1,676 per benefit period, which must be paid before Part A covers costs for the first 60 days of a hospital stay. A benefit period starts upon admission and ends after the patient has been out of the hospital or skilled nursing facility for 60 consecutive days.
Should the hospital stay extend beyond 60 days, daily coinsurance payments apply; for 2025, this is \\)419 per day for days 61 through 90. Part B costs are calculated separately, beginning with the annual deductible, which is \$257 for 2025. After this deductible is met, the patient is responsible for a standard 20% coinsurance of the Medicare-approved amount for all Part B services, including the surgeon’s and anesthesiologist’s fees.
The Role of Supplemental Insurance and Post-Operative Care
Beneficiaries often manage financial exposure from deductibles and the 20% coinsurance through supplemental coverage options. Medigap, or Medicare Supplement Insurance, is designed to cover the cost-sharing gaps left by Original Medicare Parts A and B. A Medigap policy can reduce the patient’s out-of-pocket responsibility for AAA surgery by paying the Part A deductible, the Part B deductible, and the 20% Part B coinsurance.
Medicare Advantage (Part C) plans offer another avenue, providing all the coverage of Original Medicare. These plans often substitute copayments and fixed fees for traditional Part A and B cost-sharing and may include a yearly out-of-pocket spending limit. Following the procedure, Medicare Part D, the prescription drug benefit, covers necessary medications, such as pain management drugs, blood pressure medication, or statins, required for recovery and long-term cardiovascular health management.