Medicare Billing

The final frontier. Deciding when, if and how.
robertm
Posts: 151
Joined: Mon Mar 11, 2013 11:53 am

Medicare Billing

Postby robertm » Mon Jan 31, 2022 1:58 pm

I will need an implant in the near future and I'm approaching 65. Does Medicare pay any or all of the cost of an implant: Parts, labor and hospital?
60 yrs old. Gradually worsening ED for 10 years. Pills and trimix not working well anymore. Will need an implant in the near future.

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SteveSW
Posts: 977
Joined: Sat Sep 08, 2018 6:23 pm
Location: St. Louis, MO

Re: Medicare Billing

Postby SteveSW » Mon Jan 31, 2022 3:50 pm

In my case Medicare and my supplemental plan paid 100% of costs. No out of pocket at all. Without a supplemental plan, I think Medicare picks up about 80%...and the out of pocket could be a big bill.
20 years of severe Peyronie's plaque, 90 curve, hinging and ED. Cost me 1.5" L and 1" G.
Implanted 2/18/21, AMS CX, 18 CM + 3 RTE, penoscrotal. Have gained 3/4". Gay, married, age 68.

Leebert
Posts: 567
Joined: Wed Aug 07, 2019 9:51 pm

Re: Medicare Billing

Postby Leebert » Mon Jan 31, 2022 7:52 pm

Im on the medicare priority edge and pd a $325 co pay and thats all.
I'm 65, heart attack w/stent 10 yrs ago, mod.HBP, married 46 yrs, retired.2 strokes.No damage, except start of Ed, Live in Ada Michigan. implanted by Dr. Wise in Grand Rapids mi. Implanted on 9/2/21 with 15 cm + 5cm rte. Ams 700 cx ms pump

evank64052
Posts: 18
Joined: Tue Apr 06, 2021 4:45 pm

Re: Medicare Billing

Postby evank64052 » Thu Feb 03, 2022 10:46 am

Pretty much the same for me. This is a medicare approved expense. I paid $250 only because of an extended night in the hospital.

Old Guy
Posts: 2703
Joined: Tue Mar 31, 2020 4:31 pm
Location: Ohio

Re: Medicare Billing

Postby Old Guy » Thu Feb 03, 2022 11:27 am

If you only have straight Medicare I believe it won't cover that surgery. If you have any other insurance and Medicare Part B it should be 100% covered. With Medicare Part B only your co-pay will be 20%. Since the surgery is anywhere from 16K to 25K (or more) that's one big co-pay. Many implants are done on an out-patient basis now, so no hospital stay.
Nov. 8, 2019
4+ years, Coloplast Titan OTR
Married 36 years to my beautiful young bride
Always here to answer questions if you PM me

sweaterfan
Posts: 65
Joined: Sun Sep 06, 2020 7:39 pm
Location: Austin TX

Re: Medicare Billing

Postby sweaterfan » Thu Feb 03, 2022 3:59 pm

Just be sure to understand the difference between a Medicare Advantage plan (Part C) and a Medicare Supplement plan. An Advantage plan replaces Part B and may have exclusions while a Supplement plan will supplement Part B, so if Medicare covers the procedure then the supplement plan will take care of the 20%. Advantage plans typically cost less because there are more restrictions while supplement plans cost more but provide greater choice of procedures and providers. Advantage plans can also include dental and vision services while you would have to find your own plans with a supplement plan. Lots to consider :).
Born 1956, TRT, Peyronies (no improvement after 1 cycle of Xiaflex so discontinued), using alprostadil but have possible VL. Considering an implant. Aquablation for BPH Nov 2 2020, TURP 6/14/2021.


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