Does Medicare Cover Cervical Disc Replacement?
Fair Square Medicare

Does Medicare Cover Cervical Disc Replacement?

Doctor demonstrating upper cervical spine anatomy stock photo

By Daniel Petkevich

Jan 20, 2023

People over 60 do not have coverage

Searching for the right solution to your back problems can bring its own pain. If you are seeking Medicare coverage for a cervical disc replacement, Medicare is unlikely to cover it for most beneficiaries. No coverage could mean tens of thousands of dollars spent out-of-pocket for this procedure. Read on to see if you might qualify as one of the few eligible beneficiaries.

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Overview of Medicare coverage for cervical disc replacement

Unfortunately, Medicare has a national noncoverage notice for cervical disc replacement for beneficiaries over the age of 60. However, if you are under 60 and meet certain criteria, Medicare may help pay for cervical disc replacement surgery. The CMS has a local coverage notice for those under 60, which means you need to meet certain stipulations to get coverage. In order to qualify for coverage, you must have undergone a series of non-surgical treatments that did not improve your condition, and a Medicare-enrolled doctor or facility must perform the surgery. Additionally, the procedure must fall within certain guidelines established by Medicare, and your doctor must provide documentation of your medical condition to support the need for cervical disc replacement.

How does the age limit affect eligibility for cervical disc replacement surgery?

The age limit does affect eligibility for cervical disc replacement surgery. Medicare does not cover this procedure for beneficiaries over the age of 60, regardless of any other requirements they may meet. However, those under 60 may be eligible to receive coverage depending on their individual circumstances.

How much does a cervical disc replacement cost?

Many people opt for cervical disc replacement as a cheaper alternative to more intense back surgery. The cost of a cervical disc replacement procedure varies depending on factors such as the type of disc being replaced, the hospital or medical facility performing the surgery, and any other associated costs. You will see many estimates out there for the cost, but according to Spine.MD, you can expect to pay between $30,000 to $50,000 for a cervical disc replacement.

Alternatives to traditional cervical disc replacements for those over the age of 60

If you are over the age of 60 and ineligible for cervical disc replacement surgery, there may be other options available to you. Your doctor can discuss alternative treatments that may provide relief from your condition. These could include physical therapy, steroid injections, nerve blocks or non-surgical spinal decompression.

Tips on how seniors can still access quality care despite the restrictions imposed by Medicare

Even if Medicare does not cover the procedure you need, there are still ways to access quality care. Requesting a referral from your primary care physician is one option; they may be able to recommend a specialist who is able to provide appropriate treatment for your condition. Additionally, you can look for programs or services that offer discounts on treatments or procedures that are not covered by Medicare.

Resources and support available to help seniors navigate their options

Navigating Medicare coverage and understanding your options can be confusing. Fortunately, there are resources available to help seniors make informed decisions about their health care. The Centers for Medicare & Medicaid Services (CMS) provides information on coverage options and financial assistance programs. Additionally, the National Institute on Aging offers resources and support for those aged 60 and older.

Questions to ask your doctor about your specific situation with regard to cervical disc replacement coverage

It is important to ask your doctor questions about your specific situation and the coverage options available to you. For instance, what criteria do I need to meet in order to be eligible for cervical disc replacement surgery? Are there any alternative treatments that may provide relief from my condition? What resources are available to help me access quality care? Knowing the answers to these questions can help you make an informed decision about your health care.

Takeaway

In conclusion, Medicare does not cover cervical disc replacement for beneficiaries over the age of 60. However, seniors may still be able to access quality care through referrals, discount programs and resources available. It is important to have a conversation with your doctor about the right treatment for you. This content is for informational purposes only. If you have questions about Medicare coverage or your plan, call an expert at Fair Square Medicare.

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