Will Medicaid Pay for Hysterectomy? Everything You Need To Know

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A hysterectomy is a surgical procedure aimed at removing the uterus and sometimes the cervix.

This results in the cessation of menstruation and renders the individual incapable of getting pregnant.

It stands as a common treatment for various conditions affecting the female reproductive system.

Reasons for getting a hysterectomy include addressing conditions like:

  • abnormal bleeding
  • fibroids
  • gynecologic cancers
  • endometriosis

It offers relief and addresses health concerns for affected individuals.

Below I explain the Medicaid coverage for hysterectomies and the various factors considered.

will medicaid pay for hysterectomy

Medicaid Coverage

Medicaid serves as the leading program offering wide healthcare coverage and long-term services and support to individuals with low incomes in the United States.

It generally covers medically necessary procedures, including hysterectomies.

However, the specific needs and coverage for treatment may vary by state.

What are Medically Necessary Procedures?

These are healthcare services or provisions required for diagnosing or treating an illness, injury, condition, or disease.

Its symptoms must adhere to accepted medical standards.

Below are examples of conditions that qualify for a medically necessary hysterectomy:

  • Malignant and pre-malignant lesions of the female reproductive tract
  • Endometriosis
  • Adenomyosis
  • Leiomyomas or fibroids
  • Salpingitis and oophoritis
  • Mild to moderate cervical dysplasia, when prior conservative procedures
    failed.
  • Hyperplasia of the endometrium
  • Dysfunctional uterine bleeding
  • Inflammatory peritonitis
  • Intractable procidentia (prolapsed uterus)
  • Perforation of the uterus by IUD
  • Class IV or V pap smear
  • Prophylactic oophorectomy for positive family history of BRCA-1 (breast
    cancer gene)
  • Traumatic injury to the uterus with beyond repair damage
  • Complications of giving birth such as uterine rupture

State Variations

The Medicaid coverage varies from state to state.

Therefore, you need to research and find out if your state accepts Medicaid regarding your specific condition.

You can read about all this information on the Medicaid website.

Note that some states may require prior authorization for the procedure.

This means a check is done to see if something is needed for medical reasons and to check how much it might cost before permission is given.

Conclusion

Even though Medicaid usually covers important surgeries to remove the uterus, the rules can be different in each state.

To find out exactly what’s covered in your area, I recommend talking to your doctor and looking at your state’s Medicaid website.

These sources can provide clear information about what’s covered, any needed permission before the surgery, and how much you might need to pay.

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