Well, if you go with traditional Medicare, it's possible the out of pocket will be greater, since Part B (which it sounds like this would fall under) would require out of pocket payment of 20% of whatever Medicare covers, plus the deductible. The answer could be different if you enroll in a Medicare Advantage product. Really hard to say unless the provider can give you insight into the Medicare approved amount for this procedure, which I doubt you'll get a straight answer, especially if multiple providers (doc, medical facility, etc) are all billing Medicare.

2 years is a long time to live with a hernia, slight as it might be. I would get it fixed now, and avoid risks with it continuing to get worse.

Medicare with a part B supplement will cover it and cost you less out of pocket - the specific part B plan will dictate your out of pocket. If your plan supplement plan is "G", which is the most popular and very good, the out of pocket will be the deductible, which is about $180. If you have already met the deductible, the the surgery will cost you nothing.

With a Medicare Advantage plan will probably will pay nothing too but, there are disadvantages of these "advantage" plans. A supplemental part B plan like Mutual of Omaha, BCBS, etc is gold. But there is that obnoxious monthly charge. At 70, I pay about $200/mo. With a Medicare Advantage plan, you might not pay anything other than the Medicare charge (deducted from your SS check).

I’ve had this hernia for over 5 years and while it hasn’t been an issue I do want to have it repaired. I haven’t looked into any of the Medicare plans, only that I have to get it at 65. Was actually thinking about having it done this year during the pandemic until the second wave kicked in. With no racing available this seemed like a good time to have an operation, unless there was a compelling reason to wait for Medicare, like saving a few thousand dollars.

I would have it done now

I had it done a few years ago. All good no problems

If you are in Central FL I know a great surgeon for this

I work for a Medicare Supplement insurance company- former actuarial analyst now just working with data. I told my parents to get traditional Medicare with a Medicare Supplement, or Medigap insurance. In the long run traditional Medicare will cover what a doctor prescribes, and the supplement will pay their share of whatever Medicare covers. Medicare Advantage is an HMO and will take the traditional HMO path of denying coverage, covering less expensive options, and in general making things difficult and cheaper. My father was diagnosed with lung cancer and because of emphysema, would not have been able to handle the standard of care offered by HMOs- straight radiation. Because of his circumstances, he was eligible for CyberKnife radiation treatment. The doctor told him he was lucky to have Medicare because a HMO would not have covered it. It was 6 figure treatment and my father was out of pocket $1024.

In your case you can do the math by looking at your HMO and getting pre-authorization, then comparing that to Medicare and a supplement or just Medicare. If your private insurance will pre-authorize it, it might be best to get it down and not wait around for a few years.

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"Remember: a bicycle is an elegant and efficient tool designed for seeking out and defeating people who aren't as good as you."

--BikeSnobNYC

Be very careful with advantage plans. There’s no way to look up what meds they cover, and I see nothing but limitations in my office.

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Dr Jay
http://www.Tri-Pod.net

I have one also and have had it for about as long as you have had yours.

My doctor said I could wait or go ahead and have it fixed. He said the risk of not having it fixed is that "One day when you're lifting your luggage off the carousel on a beautiful island it will grab you and you'll fall to the floor. But fortunately, this is an easy, everyday type surgery and is not difficult to repair, even on an island."

Of course I didn't have to worry about that in 2020 and probably for the first half of 2021. But the point was it's not really too dangerous to wait.

I know very little about Medicare. My private coverage has a larger deductible than yours, so when I went to get a quote for the repair the cost was around $5,000 (Houston area). 20% of $5,000 is half your current deductible.

If I was in your shoes, I'd asked my doctor what he/she recommends. Mine still says it's up to me.

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Not a coach. Not a FOP Tri/swimmer/biker/runner. Barely a MOP AGer.
But I'm learning and making progress.

CMS sets the fees for Medicare. CMS publishes the Medicare fee schedule each year:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FeeScheduleGenInfo


As to traditional Medicare (FFS) and Medicare Advantage (managed care plans--some but not all are HMO types), my experience helping elderly relatives make choices is:
1) If you live in an area with many providers, you are probably better off with FFS. That's because you are not limited to the MA plan's network.

2) If you live in a rural area with a small number of providers and are in good health (in part evidenced by no prescription drugs), then you may be better off with an MA plan. That's because that MA plan probably has to cover most or all of the providers in your area to meet network adequacy requirements.


3) If you go with an MA plan, be sure to review options each year during open enrollment. Plans count on you to just stick with what you initially choose, and often up the premiums. I've found that AARP plans (aka UnitedHealthCare) are particularly bad about this. Additionally, plans enter and leave the market. Better choices may become available year to year.


4) Whichever you choose, be sure to pay attention to the IRMAA limits. Specifically, your income at age 63 determines your IRMAA amount at age 65. Many people get tripped up by this lag.


https://www.medicare.gov/your-medicare-costs/part-b-costs

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No coasting in running and no crying in baseball