Does Medicare Cover a Hysterectomy?

A hysterectomy is a surgical procedure that removes the uterus, and in some cases, the ovaries and fallopian tubes.

In a total hysterectomy, the entire uterus — including the cervix — is removed. In contrast, a supracervical or partial hysterectomy removes the upper part of the uterus, but the cervix is left in place.

A hysterectomy that includes the removal of one or both ovaries and fallopian tubes is called a total hysterectomy with salpingo-oophorectomy.

Hysterectomies can be performed in several ways.

Hysterectomies are performed for a variety of reasons. Some women undergo a hysterectomy to prevent future pregnancy while others do so to treat an illness or disease.

According to researchers at Columbia University, hysterectomies are one of the most common surgical procedures among women.

Estimates suggest that 1 in 9 women will undergo a hysterectomy during their lifetime and approximately 600,000 procedures are performed in the U.S. each year.

Medicare will only cover a hysterectomy or other sterilization surgery when it is deemed necessary to treat an illness or injury — such as removal of the uterus because of a tumor or the removal of diseased ovaries.

A doctor must determine that the procedure is medically necessary.

According to the National Women’s Health Network, some examples of medically necessary hysterectomies include unmanageable infection, unmanageable bleeding or cancer of the uterus, cervix, vagina, fallopian tubes or ovaries.

Original Medicare (Part A and Part B) as well as Medicare Advantage plans provide coverage for medically necessary hysterectomies.

Benefits also cover lab work, office visits and diagnostic testing.

Medicare will not cover elective hysterectomies, tubal ligation or vasectomies if the primary goal of these procedures is sterilization.

This is true even if a physician believes another pregnancy would endanger the overall general health of the women.

The Centers for Medicare & Medicaid Services has not released a specific National Coverage Determination for hysterectomy procedures performed for benign conditions. However, Medicare Advantage plans can create their own coverage determinations in these situations.

Medicare Advantage, or Part C, is a plan administered by a private insurer and must provide the same benefits as Original Medicare.

United HealthCare, which administered 28 percent of all Medicare Advantage plans in 2022, provides guidance on situations when a hysterectomy may be covered for a benign condition.

This can include uterine fibroids, endometriosis, pelvic organ prolapse and abnormal uterine bleeding.

To see if a hysterectomy is covered for your treatment or condition, speak with your doctor and Medicare plan provider.

It can be difficult to know the exact cost of a surgery or procedure in advance.

However, there are a few costs to expect.

If you’re having a hysterectomy, your Part A and Part B deductibles apply. You can log into your My Medicare account to see if you’ve met your deductibles yet.

After meeting your deductibles, Medicare pays 80 percent of all approved costs. You’ll be responsible for the other 20 percent if you don’t have any supplemental insurance, such as Medigap or Medicaid.