Cardiac bypass is the most common type of heart surgery performed on adults in the US. What’s not common is finding two patients who have paid the same amount for the procedure. As with most health services, the price you’ll pay for bypass surgery depends largely on the facility performing the operation and the region of the country where it’s located. The cost will also depend on any complications involved.
Average Bypass Surgery Cost
According to Debt.org, the average cost of bypass surgery in the US in 2018 was $123,000. That included:
- Operating room fees. This is the hourly rate to rent the operating room.
- Anesthesia. This is the fee of the anesthesiologist who administers the anesthesia necessary for your surgery.
- Surgeon’s fees for the operation.
- Pre- and post-operation hospital stay. This is based on an average hospital stay of 6-7 days for bypass surgery.
- Pre-surgical treatment. This could be catheterization or any other treatment necessary to ensure that the bypass surgery is successful.
- Anti-rejection medication. This medication prevents your body from rejecting the new arteries.
- Pre-op visits with the surgeon.
What the total doesn’t include:
- Insurance premiums. This is the monthly fee you have to pay just to keep your insurance active. You may also be responsible for your annual deductible and will have to pay any applicable co-payments until you reach your out-of-pocket maximum. Those charges are on top of your monthly insurance premiums.
- Physical therapy after the operation. After bypass surgery, most patients need physical therapy to learn how to move properly without harming the incision. They also must learn exercises that will assist in recovery. Physical therapy can cost between $50 and $350 an hour and might not be covered by insurance.
- Additional medications you might need. These could include blood-thinning medication to prevent blood clots ($15-200 per month), beta-blocker medication to slow your heart rate ($10-200 per month), statins to lower your cholesterol ($10-200 per month), and an ACE inhibitor to control your blood pressure and prevent heart failure ($10-100 per month).
- Lost wages.
- Additional miscellaneous expenses like caregiving, travel and anything else you might have to pay as a result of having bypass surgery.
What Will You Pay?
If you have insurance, you’ll be responsible for paying your monthly premiums and for all costs up to the amount of your policy’s deductible. If your deductible is $5,000, for example, then you’ll have to pay for the first $5,000 of your care before your insurance will kick in (unless you’ve already incurred other costs for the calendar year which would count against the deductible). After that, your insurance will probably require you share in the cost of your care. If so, the amount you’re responsible for is called the “co-payment” or “co-insurance.”
Your health plan also has a maximum out-of-pocket amount. This is the most you’re required to pay out of pocket for your medical care in any calendar year. Since the cost of bypass surgery is so high, you’ll almost certainly hit the out-of-pocket maximum before the total cost of the surgery has been paid. At that point, your insurance will cover all remaining covered charges, except for the miscellaneous expenses mentioned earlier.
To get a realistic estimate of the amount you’ll have to pay for bypass surgery if you are covered under health insurance, just look at the maximum annual out-of-pocket limit on your policy. Chances are, you’ll end up paying just about all of that amount.
If You Are Covered by Medicaid or Medicare
There’s relatively little to worry about if you have Medicaid coverage and have to undergo coronary bypass surgery. Aside from any monthly premiums you may have to pay if you also receive Social Security, Medicaid covers 100 percent of a bypass procedure, without deductibles or copays. The only other costs you may have to pay out-of-pocket are for physical therapy or non-prescription medications, depending on how robust your state’s Medicaid policies are.
Medicare is more complicated. Those who only have basic Part A (in-patient) and Part B (outpatient and emergency room) coverage will still be responsible for 20 percent of approved charges (and 100 percent of non-approved charges) after the small minimal deductible is satisfied. That can be tens of thousands of dollars for a heart bypass.
For that reason, 95 percent of Medicare patients opt for more-expensive Medicare Advantage or supplemental plans. Advantage places a maximum limit on out-of-pocket costs, while supplemental coverage pays for almost everything that traditional Medicare doesn’t cover. These plans are well worth their cost, since older patients are more likely to require expensive medical or surgical treatment over time.
What if You Don’t Have Insurance?
The best advice, of course, is to get insurance if you don’t have it. That’s easier said than done, though, particularly if you’ve had a heart attack and the doctor says that you need immediate cardiac surgery. It’s unlikely that you’ll be able to enroll in a health care plan while you’re being wheeled from the ER into the operating room.
However, if you suffer from recurring chest pain or have been diagnosed with coronary artery disease – and you don’t have health insurance – it’s still possible to sign up for coverage before you potentially need surgery. The Affordable Care Act (also known as Obamacare) guarantees that you can’t be turned down because of an existing condition. So patients with heart disease are now able to buy insurance coverage before their disease progresses to the point when they need a coronary artery bypass graft or other expensive procedure.
If you have to have surgery without insurance, many hospitals give patients who pay in cash a 30-35 percent discount. But even with a 35 percent discount, you could still end up being responsible for $80,000 or more in medical bills.
In order to reduce the cost of surgery, make sure to shop around. Fees will differ between facilities, surgeons, anesthesiologists, and pharmacies, even if they’re within the same region. Be sure to ask for a complete cost breakdown for your procedure or medications before choosing which providers you’ll use.
Another thing to remember is that it’s OK to negotiate. Health insurance companies negotiate the cost of their patients’ care all the time, but it’s not an option that occurs to most individual patients. However, it is possible. To find the best deal, contact the billing department of each facility and ask for the best rate they offer insurance companies. If you’re nice, they just might give it to you.
One final option might be to investigate the possibility of having your heart bypass surgery done in another country where costs are much lower. “Medical tourism” has become a big business, with more and more American patients choosing to have their operations in nations like India, Costa Rica or Mexico.
Those countries have major medical centers with highly-regarded cardiologists on staff, and the cost of procedures is significantly lower than in the United States. For instance, a coronary bypass averages around $10,000 in India and $40,000 in Mexico (not including travel to and from the destination, or in-country recovery after release from the hospital). Obviously, that’s a bargain compared to the $123,000 the average procedure costs in America.
The cost of your bypass surgery will depend mostly on where you’re having the surgery done and the complications involved. Before choosing a hospital and surgeon, make sure you understand what their total cost estimate is, what it includes and what your insurance is going to cover. After all, the only thing worse than recovering from major surgery is being surprised by an enormous hospital bill in the mail during your recovery.
More Articles in This Series:
Disclaimer: the content presented in this article are for informational purposes only, and is not, and must not be considered tax, investment, legal, accounting or financial planning advice, nor a recommendation as to a specific course of action. Investors should consult all available information, including fund prospectuses, and consult with appropriate tax, investment, accounting, legal, and accounting professionals, as appropriate, before making any investment or utilizing any financial planning strategy.