Your doctor may recommend anesthesia for certain medical procedures. Medicare coverage varies according to the procedure and medical necessity.
Original Medicare covers anesthesia for a variety of services when deemed medically necessary – but there are exceptions. On this page, we look at the different types of anesthesia Medicare covers, including general, local, and sedation, and which procedures are generally exempt from Medicare coverage.
Medicare coverage for anesthesia
If you’re an inpatient in a hospital, Medicare Part A (hospital insurance) covers anesthesia services. Inpatient hospital care is covered if you’re admitted as an inpatient after an official doctor’s order and the hospital accepts Medicare. During this time, your Part A benefits will pay for both your hospital stay and anesthesia costs, which can vary depending on the location, admission status, and other coverage.
If you’re an outpatient in a hospital or patient in a freestanding ambulatory surgical center, anesthesia is covered by Medicare Part B (medical insurance). Part B also covers any doctor services you receive as part of your treatment.
Original Medicare does not cover anesthesia for cosmetic or electric procedures. It also may not cover dental anesthesia, so contact Medicare to learn more.
If you have a Medicare Advantage (Part C) plan, anesthesia services will be covered as well. However, some anesthesiologists may not participate with your specific plan and therefore, their fees would not be covered. Before getting surgery, contact your particular insurance plan to learn what is and isn’t covered and whether the providers are in-network.
Types of anesthesia
There are four main categories of anesthesia: General, regional, sedation (sometimes called “monitored anesthesia care”), and local anesthesia.
General anesthesia is typically what people think of when they hear “anesthesia.” This anesthesia requires complete unconsciousness and the assistance of a machine for breathing, and you have no awareness or sensations. Sometimes this is administered via gases or vapors given through a breathing tube or mask or via medications given through an IV.
Regional anesthesia makes an area of the body numb, preventing you from feeling pain. It can completely block sensations to the area of the body that requires surgery and is administered via an injection near the cluster of nerves that provides sensation to that area.
The two most common types of regional anesthesia are spinal and epidural anesthesia, often used for childbirth and total knee and total hip replacements. Nerve blocks are another type of regional anesthesia that can provide pain relief and numbing to smaller areas, such as an arm or leg.
You don’t have to be completely awake for regional anesthesia, and most patients prefer to get some sedation so they can relax during the procedure.
This is what people sometimes refer to as “twilight.” Medications are given (typically through an IV) to make you feel drowsy and relaxed. There are different levels of sedation possible depending on the procedure and patient preferences.
When under mild sedation, the patient is awake and able to respond to questions. With moderate sedation, the patient may be able to doze off but can awaken easily. Deep sedation is similar to general anesthesia, but the patient is able to breathe without assistance.
Local anesthesia medications such as lidocaine are injected through a needle or applied as a cream to numb a small area. This can provide pain relief for limited procedures, such as getting stitches or filling a cavity, and can also be used along with sedation for minor outpatient surgery.
Who provides anesthesia?
An anesthesiologist is the one who administers anesthesia, manages your level of consciousness and sleep during the procedure, and makes sure your vital signs (like heart rate, blood pressure, temperature, and oxygen levels) are stable. If there’s a problem during surgery, the anesthesiologist will help fix the problem.
You will meet with your anesthesiologist the day of your surgery to ask any questions or express concerns.
Are there risks with getting anesthesia?
Your anesthesiologist will work to create a plan specific to your needs before, during, and after your surgery to help minimize risks. However, some common side effects include headache, pain at the injection site, nausea, and vomiting.
Can I eat before getting anesthesia?
You will be given specific instructions about eating and drinking by either a nurse, your doctor, or your anesthesiologist. Typically, you should stop eating at least eight hours before your procedure.
Can I take medications before getting anesthesia?
Talk to your doctor about whether you should or should not take any prescribed medications before your surgery. Or, ask about medications when you’re contacted by a nurse prior to your surgery. You may want to bring your medications with you.
Will I wake up during surgery?
It is extremely rare to wake up while under general anesthesia.
What if I have sleep apnea?
If you have sleep apnea, you should tell your surgeon, anesthesiologist, and other hospital staff. If you use equipment for your sleep apnea, such as a nasal continuous positive airway pressure (CPAP) mask, you should bring it with you to the hospital on the day of your surgery.
How long does it take to recover from anesthesia?
After your procedure, you’ll be moved to the Post-Anesthesia Care Unit (PACU) and once you are stable and awake, you may be able to see family. It typically takes between one to four hours for the body to completely recover from general anesthesia.
If you have local or regional anesthesia, it may only take a few minutes up to a few hours to recover.
You may continue to feel sleepy for up to 24 hours.
Does Medicare cover anesthesia for a colonoscopy?
Yes, Medicare pays the full cost of a screening colonoscopy, including anesthesia. How your benefits pay depends on whether the procedure is outpatient or inpatient.
Does Medicare cover anesthesia cataract surgery?
Yes, Medicare covers anesthesia for cataract surgery, both traditional and laser. Before the procedure the doctor will numb the eye area with a local anesthetic, which is covered by Medicare benefits.
Does Medicare Advantage cover anesthesia?
Medicare Advantage plans have to cover everything Original Medicare does, so medically necessary anesthesia is also covered. However, MA plans also operate with provider networks, so you must ensure your anesthesiologist is in the plan’s network.
Comparing the costs and benefits of Medicare plans is easy with our Find a Plan tool. Just enter your zip code to start reviewing Medicare plans in your area. Or, call us toll-free at 888-992-0738 and one of our licensed agents will answer your questions and help you find the right Medicare coverage for your unique needs.