Does Medicare Cover Bunion Surgery?

Does Medicare Cover Bunion Surgery?

While bunions are extremely common and typically cause few problems, some cases are more severe and may even require surgical intervention.

Feet often change as we get older, such as the big toe starting to lean toward the other toes and a bump forming on the joint at the base of the big toe. This is called a bunion, and it’s estimated that one out of three people over the age of 65 have a bunion to some degree. It’s one of the most common foot ailments, and most people who have bunion deformities have mild or no symptoms at all.

However, in some cases, a bunion can be painful and cause severe pressure, and your provider may recommend surgery. Read on to learn more about Medicare coverage for bunion surgery and other foot care.

What are bunions?

A bunion is a bony bump that forms on the joint at the base of your big toe. Bunions happen when some of the bones in the front part of the foot move out of place, causing the tip of your big toe to get pulled toward the smaller toes and forcing the joint at the base of the toe to stick out.

Smaller bunions (called bunionettes) can develop on the joint at the base of your little toe.

What causes bunions?

Bunions can be caused by wearing tight, narrow shoes, or as the result of the shape of your foot, a foot deformity, or a medical condition like arthritis. Particular inflammatory types, such as rheumatoid arthritis, often cause bunions.

Additionally, it’s believed that there is some genetic component to developing bunions.

Symptoms of bunions

Symptoms of bunions can include a bulging bump on the outside of the bottom of your big toe, swelling, redness, or soreness around your big toe joint, corns or calluses (typically where the first and second toes rub together), ongoing pain or pain that comes and goes, and limited movement of your big toe.

Types of bunion surgery

Surgical removal of bunions is called a bunionectomy. This operation is typically performed in an outpatient setting with a local anesthetic.

There are actually dozens of types of bunion surgery, and the one your surgeon chooses depends on the size and development of the bunion. However, there are a few more common types of surgery including osteotomy (the surgeon cuts the big toe joint and realigns the bone to correct the deformity), exostectomy (the surgeon removes the bunion without the subsequent realignment), and arthrodesis (the removal of the damaged joint and replacement with screws and metal plates.

Following the surgery, your surgeon or podiatrist will likely recommend you wear a boot or cast and use crutches as walking aids to protect your foot until it’s fully healed.

General recovery can take six to eight weeks, though full recovery can take up to six months. Your doctor may recommend physical therapy sessions to help re-strengthen your foot and ankle.

Medicare coverage for bunion removal surgery

If you are experiencing pain and swelling in your toes and the bunion is making it hard to walk, you may want to consider bunion surgery. Medicare Part B (medical insurance) does cover medically necessary bunion treatment and surgical procedures. It also covers any medically necessary supplies, such as a boot or crutches, and other visits to a doctor’s office or podiatrist.

In some cases, you provider may have to send proof of medical necessity in order for Medicare to cover the procedure. Your physician will handle this request and send in the documentation needed.

If you have a Medicare Advantage plan, bunion surgery would also be covered as long as it’s considered medically necessary. Part C plans must provide at least the same benefits as Original Medicare, so any treatment or surgery for bunions that are covered by Part B would also be covered by your plan.

Your Part D prescription drug coverage would cover any pain or anti-inflammatory medications your provider may prescribe before or after the surgery.

Medicare coverage for foot care

Medicare Part B covers podiatrist foot exams or treatment if you have diabetes-related nerve damage, or need medically necessary treatment for foot injuries or diseases (like hammer toe and heel spurs). Note your podiatrist or physician must accept assignment in order for the services to be covered.

How much does bunion surgery cost?

If the surgery is covered by Part B, you must pay the Part B deductible and 20% of the Medicare-approved amount of the cost of the procedure. Medicare pays the other 80% of the cost.

The actual out-of-pocket cost depends on where you live, your insurance coverage, the type of procedure you need, and other factors. The average cost of bunion surgery is around $5,500, though costs can range from $3,500 to $12,000 or more. If your procedure is not covered, you’d owe 100% of that cost out of pocket.

If you have Medicare Supplement Insurance (Medigap), it may help cover some of the out-of-pocket costs associated with bunion surgery and other podiatry services. For example, it may cover any outstanding deductible, coinsurance, and copayments you may have.

Alternatives to bunion surgery

Not all bunions are severe enough that surgery is required. Instead, your provider may just recommend rest, anti-inflammatory medications, corticosteroid injections, and/or orthotics (special shoe inserts). If your podiatrist recommends orthotics, Medicare Part B may cover one pair of custom-molded inserts if you meet certain requirements and your supplier accepts assignment.

Talk to your doctor about which treatment may be right for you.

How to prevent bunions

Because bunions are often caused by foot deformities or medical conditions like arthritis, there’s not much you can do to prevent them. However, one action you can take is to choose your shoes wisely. They should have a wide toe box, meaning no pointy toes, and there should be space between the tip of your longest toe and the end of the shoe. Your shoes should conform to the shape of your feet without squeezing any part of your foot.

Additional resources

After retiring from a career as an executive travel counselor in 2006, Donna Frederick embarked on a second career as a licensed insurance agent. During that first year, many clients told Donna how overwhelmed they felt by Medicare, but that her assistance helped them finally understand the Medicare program. That experience inspired Donna to focus her efforts on educating her clients to ensure they fully understand their Medicare options. Today, Donna takes pride in providing outstanding customer service and going the extra mile to make sure each client knows all of their options and has a sound understanding of their Medicare plan, from costs to coverage and all points in between.


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