Medicare covers appendix surgery when it’s medically necessary. This is usually to treat appendicitis, which is a medical emergency.

Appendix surgeries are used to treat appendicitis, a common medical emergency involving inflammation of the appendix. They’re one of the most commonly performed surgeries in the United States.

In fact, approximately 300,000 hospital visits in the United States each year are for appendicitis-related issues — and many of them involve surgery.

If you ever need appendix surgery, it’s helpful to know that Medicare will cover it.

When to seek emergency care

Appendicitis is an emergency. Seek emergency care immediately if you have:

  • dull, cramping pain in your abdomen that turns into a sharp pain
  • abdominal pain and fever (which will get higher if your appendix ruptures)
  • abdominal pain and an increased heart rate
  • digestive symptoms such as nausea, vomiting, constipation, diarrhea, or trouble passing gas

Medicare covers surgeries when they’re medically necessary. This includes appendix surgery, also called appendectomy.

If your appendix surgery treats a condition or its symptoms, Medicare will consider it medically necessary. And since appendix surgery is usually an emergency procedure to treat appendicitis, it will meet Medicare’s definition of medically necessary.

In other possible scenarios, you may undergo abdominal surgery for another medically necessary condition, and your doctor decides removal of your appendix is needed as a preventive measure. Depending on your specific situation, Medicare may not cover the removal part of the surgery if it disagrees that this is medically necessary.

Medicare coverage varies depending on the type of appendix surgery you get and any possible complications. The parts that may cover the procedure are as follows:

  • Part A: Part A covers inpatient surgeries and hospital stays, which means it would be the most likely part to cover an appendectomy.
  • Part B: Part B covers outpatient medical care, so it may cover the procedure if you have it as an outpatient or in an ambulatory surgical center. This may be the case with a laparoscopic appendectomy.
  • Part C: Also called Medicare Advantage, Part C offers the same benefits as Original Medicare (parts A and B).
  • Part D: Part D covers prescription medications such as pain or antibiotics after surgery.
  • Medigap: These are optional supplemental insurance plans that help pay out-of-pocket expenses not covered by Original Medicare, such as deductibles, copays, and coinsurance.

Factors to consider about Medicare Advantage

If you have a Medicare Advantage plan instead of Original Medicare, a doctor in the plan’s network may need to perform your appendix surgery.

With Medicare Advantage, you generally pay more to see healthcare professionals who aren’t in your plan’s network, and you might not even have coverage.

But if your appendix surgery is an emergency — which is usually the case — this might not apply.

Most Medicare Advantage plans allow you to use an out-of-network hospital in an emergency. If possible, it’s a good idea to contact your specific plan to understand your coverage options in an emergency.

A 2022 study of 4,700 laparoscopic appendectomies at 20 hospitals found that costs ranged from $650 to $1,067 per case.

Generally, costs can be affected by:

  • the type of appendix surgery you have
  • the hospital where you have your surgery
  • any antibiotics you need
  • any anesthesia you need
  • your hospital stay following a procedure

Your out-of-pocket costs for appendix surgery with Medicare will depend on which Medicare part provides coverage. Here’s what to expect in terms of cost per Medicare part:

  • Part A: Most people do not pay a premium. After you meet the deductible of $1,676 in 2025, Part A covers the first 60 days of hospitalization, including in the case of appendectomy. Additional days in the hospital will incur a daily fee that increases with time.
  • Part B: This part charges a premium of $185 per month. Once you meet the $257 deductible, Part B should pay 80% of the cost of your procedure. You’ll generally be responsible for the remaining 20%.
  • Part C and Medigap: Since Medicare Advantage and Medigap plans are privately managed, your costs will depend on your insurer and the specific plan. You can find available plans in your area on Medicare.gov. Note that you cannot have Part C and Medigap at the same time.
  • Part D: The coverage of any medications you need as part of your procedure depends on your specific plan. These plans are also private. In late 2024, the Centers for Medicare & Medicaid Services (CMS) estimated the average 2025 premium for Part D plans to be $46.50.

Appendicitis is a medical emergency that requires surgery. You should always go to the emergency room right away if you think you have appendicitis.

Medicare will cover your appendix surgery and any care you need following it. The costs to you will depend on your procedure, your hospital stay, the part of Medicare you use, and other factors.