Yes, Medicare covers inguinal hernia surgery when it’s medically necessary. Most inguinal hernia repairs are performed as outpatient procedures and fall under Medicare Part B, which pays 80% of the approved cost. You’re responsible for the remaining 20% coinsurance after meeting your annual deductible.
How Medicare Pays for the Surgery
Inguinal hernia repair is one of the most common surgeries in the United States, and Medicare treats it as a standard covered procedure. Under Original Medicare, Part B covers the surgery when it’s done on an outpatient basis, whether at a hospital outpatient department or an ambulatory surgical center. The coverage includes both the surgeon’s fee and the facility fee.
If your hernia requires an inpatient hospital stay, which is less common for straightforward inguinal repairs, Part A covers the hospitalization instead. Inpatient stays are more typical for complex abdominal hernias, particularly those that are very large, incarcerated (trapped), or strangulated (losing blood supply). A standard inguinal hernia that can be pushed back into place is almost always handled as an outpatient procedure.
What You’ll Pay Out of Pocket
For 2025, the Part B annual deductible is $257. Once you’ve met that, Medicare picks up 80% of the approved amount for the surgery, and you pay the remaining 20% coinsurance. Your actual out-of-pocket cost depends on two main factors: where the surgery is performed and whether you have supplemental insurance.
Ambulatory surgical centers typically charge less than hospital outpatient departments for the same procedure. Medicare’s price lookup tool on medicare.gov lets you compare national average costs for specific hernia repair codes at both types of facilities. If you have a Medigap (Medicare Supplement) plan, it may cover some or all of that 20% coinsurance. Medicare Advantage plans set their own cost-sharing rules, so check with your plan directly for specifics.
Open, Laparoscopic, and Robotic Repairs
Medicare covers inguinal hernia repair regardless of the surgical approach your surgeon recommends. Open repair, laparoscopic repair, and robotic-assisted repair are all covered procedures. The billing codes Medicare uses explicitly include “any approach,” so you won’t face a coverage denial simply because your surgeon chooses one technique over another. That said, the total cost to Medicare (and your coinsurance) can vary between techniques since robotic and laparoscopic procedures sometimes involve higher facility charges. The clinical decision about which method is best for your situation is between you and your surgeon.
Diagnostic Tests Before Surgery
Before scheduling a repair, your doctor may order imaging to confirm the hernia or assess its size. Medicare Part B covers diagnostic tests like ultrasounds, CT scans, and MRIs when ordered by your provider. One thing to watch for: if you’re getting a CT, MRI, or similar scan at a free-standing imaging center rather than a hospital, Medicare requires that facility to be accredited. Ask the imaging center about accreditation before your appointment. If the center isn’t accredited, Medicare won’t pay for the test.
Post-Surgery Coverage
Medicare’s coverage doesn’t stop at the operating room. If your doctor prescribes a hernia support garment, such as a truss or abdominal binder, Part B covers it as a brace under the durable medical equipment benefit. This applies whether you use the support before or after surgery.
Physical therapy after hernia repair is also covered under Part B when your doctor certifies it’s medically necessary. Not everyone needs formal physical therapy after an inguinal hernia repair, since many people recover with basic activity guidelines from their surgeon. But if you’re having difficulty returning to normal movement, or if you had a more complex repair, your doctor can refer you and Medicare will help cover those sessions. The same 20% coinsurance applies to both the support garments and physical therapy visits.
What “Medically Necessary” Means in Practice
Medicare requires that any surgery it covers be medically necessary, and inguinal hernia repair generally meets that standard without difficulty. A hernia that causes pain, is growing, or poses a risk of incarceration or strangulation clearly qualifies. Even a recurrent hernia that was previously repaired is a recognized covered procedure under Medicare’s billing codes.
The situation that sometimes raises questions is a small, painless hernia discovered incidentally. In these cases, your surgeon may recommend watchful waiting rather than immediate surgery, particularly if you have other health conditions that increase surgical risk. If surgery is eventually recommended and your surgeon documents the medical reasoning, coverage typically follows. The key is that your treating physician supports the need for the procedure. Medicare does not require prior authorization for most hernia repairs under Original Medicare, though Medicare Advantage plans may have their own prior authorization requirements.