What You'll Pay for Open Heart Surgery Under Medicare

Medicare covers most of the cost of open heart surgery, but you will still owe copayments, coinsurance, and deductibles

If you have Original Medicare (Parts A and B), the program pays for open heart surgery performed in a hospital. You will not pay the full bill — Medicare negotiates the price down sharply — but you will owe your share. That share depends on whether you have met your deductible, which hospital you use, and whether the surgeon is in Medicare's network.

The exact amount varies widely by location and hospital. A teaching hospital in a major city may charge differently than a rural hospital. What matters most is understanding the three types of costs you will face: the hospital deductible, daily coinsurance while you are admitted, and any surgeon or anesthesiologist bills that fall outside the hospital's main charge.

Key Takeaways

You pay a one-time hospital deductible (currently $1,676 per benefit period) before Medicare begins to pay, then coinsurance of about $419 per day for days 61–90 of your hospital stay.
Open heart surgery typically requires a hospital stay of 5 to 10 days, so most people will owe the deductible plus a few days of coinsurance.
If your surgeon or anesthesiologist does not accept Medicare assignment, you may owe balance billing — charges above what Medicare allows — on top of your coinsurance.
Medicare Advantage (Part C) plans have different cost structures, usually with copayments instead of coinsurance, and limits on what you owe out of pocket.
Supplemental insurance (Medigap) can cover your coinsurance and deductible, reducing your out-of-pocket cost to zero or close to it.

How Original Medicare pays for the surgery itself

Original Medicare Part A covers the hospital stay, operating room, nursing care, and most supplies. Part B covers the surgeon's fee and anesthesiologist's fee. Medicare pays the hospital a bundled amount for the entire stay — not a per-day rate — so the length of your stay does not change what the hospital receives from Medicare.

You pay the Part A deductible once per benefit period (a benefit period begins when you enter the hospital and ends 60 days after you are discharged). For 2024, that deductible is $1,676. After you meet it, Medicare pays 100% of covered hospital costs for days 1–60. On days 61–90, you pay coinsurance of $419 per day and Medicare pays the rest.

Most open heart surgery patients stay in the hospital for 5 to 10 days. If your stay is 5 days, you will owe only the deductible — no coinsurance. If your stay is longer, you will owe coinsurance for each day after day 60, though this is rare for open heart surgery.

Surgeon and anesthesiologist fees

The surgeon and anesthesiologist bill separately from the hospital. If both accept Medicare assignment, they bill Medicare directly and you owe 20% coinsurance on what Medicare allows. The surgeon's share of the allowed amount is typically several thousand dollars, so your 20% coinsurance could be $1,000 to $3,000 or more, depending on the surgeon's fee and your local Medicare allowance.

If the surgeon or anesthesiologist does not accept Medicare assignment, they can bill you for the difference between their charge and what Medicare allows — called balance billing. Medicare limits balance billing to 15% above the allowed amount, but that can still add hundreds or thousands to your bill. Before surgery, ask your surgeon's office whether they accept Medicare assignment.

Some surgeons and anesthesiologists are employed by the hospital, in which case their fees are bundled into the hospital bill and you do not receive a separate bill. Ask the hospital's billing department whether your surgeon and anesthesiologist are hospital employees or independent contractors.

What Medicare Advantage plans charge instead

If you have Medicare Advantage (Part C), your plan covers the same surgery but with a different payment structure. Instead of a deductible and coinsurance, you typically pay a copayment for the hospital stay — often $250 to $500 per day, with a maximum out-of-pocket limit. Once you reach that limit in a calendar year, the plan pays 100% of covered costs for the rest of the year.

Medicare Advantage plans vary widely. Some charge no copayment for inpatient hospital stays. Others charge per day. Some have a $5,000 out-of-pocket maximum; others have $10,000 or higher. Check your plan's summary of benefits or call the plan directly to learn what you will owe for open heart surgery at your preferred hospital.

One important difference: Medicare Advantage plans may require you to use in-network hospitals and surgeons. If you have a surgeon you want to use, confirm that both the surgeon and the hospital are in your plan's network before scheduling surgery.

How Medigap supplemental insurance reduces your costs

Medigap policies are sold by private insurers and designed to cover the gaps in Original Medicare — the deductible, coinsurance, and balance billing. If you have a Medigap plan, you may owe nothing out of pocket for open heart surgery, depending on which plan you own.

Plan G, the most popular Medigap plan, covers your Part A deductible, all coinsurance, and balance billing on surgeon and anesthesiologist fees. Plan F (available only to people who turned 65 before 2020) covers everything, including the Part B deductible. If you have either plan, your out-of-pocket cost for open heart surgery is typically zero.

Medigap premiums vary by age, location, and plan type. A Plan G premium might range from $100 to $300 per month depending on where you live. If you are facing open heart surgery, the cost of adding Medigap coverage may be worth it, though you cannot enroll in Medigap during the surgery itself — you must enroll during your initial enrollment period or during an open enrollment window.

Costs that Medicare does not cover

Medicare does not cover private hospital rooms, television, or telephone charges. It does not cover experimental procedures or devices not yet approved by the FDA. If your surgeon recommends a newer type of heart valve or graft that Medicare has not yet covered, you may owe the difference between the standard device and the newer one.

Rehabilitation and home health care after surgery are covered by Medicare Part A if medically necessary and ordered by your doctor. However, if you need ongoing physical therapy or skilled nursing care beyond what Medicare covers, you will owe out of pocket. Ask your hospital's discharge planner what rehabilitation services Medicare will cover before you leave the hospital.

Steps to understand your costs before surgery

Contact your surgeon's billing office and ask for an estimate of their fee. Ask whether they accept Medicare assignment. Ask the hospital's billing department for an estimate of the hospital charge and whether your anesthesiologist is a hospital employee or independent contractor.

Call Medicare directly at 1-800-MEDICARE to confirm your deductible status and whether you have met your deductible in the current benefit period. If you have Original Medicare without Medigap, ask Medicare whether you are may be able to access to enroll in a Medigap plan before your surgery date.

If you have Medicare Advantage, log into your plan's website or call the plan to confirm your out-of-pocket maximum and whether your surgeon and hospital are in network. Ask what your copayment will be for the hospital stay and for the surgeon's fee.

Frequently Asked Questions

Will Medicare pay for open heart surgery if I am under 65?

Medicare covers open heart surgery for people under 65 who have End-Stage Renal Disease (ESRD), have received a kidney transplant, or have been receiving Social Security Disability Insurance (SSDI) for at least 24 months. If you meet one of these conditions, the same deductibles and coinsurance explore as for people 65 and older.

What happens if I have both Medicare and Medicaid?

Medicaid may pay your Medicare deductible and coinsurance if you are may be able to access for both programs. Contact your state Medicaid office to confirm what Medicaid will cover. The process and coverage vary by state.

Can I negotiate the surgeon's fee with Medicare?

No. Medicare sets the allowed amount for each procedure, and surgeons who accept Medicare assignment must accept that amount as payment in full (plus your coinsurance). You cannot negotiate a lower fee, but you can ask whether the surgeon accepts Medicare assignment before scheduling.

What if the hospital bills me after Medicare pays?

The hospital should bill you only for your deductible and coinsurance. If you receive a bill for more than that, contact the hospital's billing department and ask for an itemized explanation. You can also file a complaint with Medicare if you believe you were billed incorrectly.

Does Medicare cover the cost of getting to the hospital for surgery?

Medicare does not cover transportation to the hospital. However, some Medicare Advantage plans and Medicaid programs offer non-emergency medical transportation. Contact your plan or your state Medicaid office to ask whether transportation is covered.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.