Will medicare pay for a revision?

[ThailandBound]

Don’t need a revision.

Don’t want one.

But, when the time comes i’m wondering if anybody knows if Medicare will pay for the revision?

I paid out-of-pocket for my original surgery in January. I retire soon and will have a rather curtailed budget so have been thinking about this.

[Gt1956]

Thats a really good question. Honestly I haven't thought much about that.

Best that I can say is to relate my sister in laws experience with her pacemaker. It finally got to the point where it wasn't working very well. I'm positive Medicare covered the replacement of it. There is no way that she could of covered it. She was almost destitute living on less than $1,000 a month.

I tried to stay out of talks about her health. She got the pacemaker just after turning 65. Was admitted through the emergency room. She'd bitch that she had not wanted a pacemaker but was unconscious when they did it. So I was surprised when she consented to its replacement.

Long story & I'm only guessing. If it was originally covered by Medicare? They'll replace it.

On the other hand. My sons father in law has had a kidney transplant. The story is that once he turned 65 he couldn't get a second kidney if it failed. But I think that is related to the shortage of organs more than a Medicare rule.

[SteveD]

There's a CPT code for the procedure but not sure this is a guaranteed deal - need someone with more knowledge to give us a better answer. We know Medicare will pay for initial insertion if ED is documented by a physician and other treatments have not worked. As you approach Medicare eligibility understand how Parts A and B work and the value of supplemental insurance including a pharmacy benefit. If per chance you're retired military or a Vet under VA Care there are some other options to consider.

"CPT® 54410 describes the removal and replacement of all components of a multi-component, inflatable penile prosthesis."

[Jage64]

Yes, I believe they will. Dr. Clavell mentioned this to me prior to my surgery. I asked him about the new technology I had been hearing about in regard to implants and whether I should wait. He said get this one now, enjoy the hell out of it and the next one with all the new tech will be on Medicare's bill (I'm 58)

[SteveD]

I love that attitude - 'enjoy the hell out of it!!' We need more healthcare professionals like Clavell!

[JetAirliner]

Thai .. Make sure that when you sign up for Medicare that you also purchase a Medicare Supplement plan to cover the the 20% that regular Medicare Part A & B “potentially may not “ cover

[Old Guy]

Medicare has 2 parts, Medicare A is the one you will get automatically when you turn 65. It covers emergency hospital admissions like a stroke, heart attack or broken bones. You still end up with a sizeable bill.
Medicare Part B is optional coverage you have to pay for monthly out of your SS check. It covers a lot more medical expenses like doctor visits, some medical equipment and surgeries. There are options to Part B seen as Medicare Advantage plans and other Part D, F, G. etc. (They keep making up new ones) There is an annual limit for your out-of-pocket expense but there is also a 20% co-pay for many services. The Advantage plans are similar but have tighter limits on some things.

If you have Medicare Part A & B and a private medical insurance plan like Blue Cross or United Healthcare the implant or revision will be zero cost. I had Part A and United when I had mine done and my co-pay was around $3,500. Billing lady told me to sign up for Part B and it would be free. I wasn't waiting once I decided.

[beachbum1]

Just seen this thread. I just got a
Replacement. 08/23/23. Medicare has paid for both the original and the replacement. As others have said, once your are eligible for Medicare and sign up, be sure to get a supplement plan with someone. My replacement, Medicare was billed I think somewhere around $22000+. Medicare approved I think $17000 and paid 80% my suplamental insurance covered the 20% cost me nothing out of pocket.

[jwitten567]

yes they will (or majority if you don't have supplemental or secondary insurance)

[NorCol]

Had initial and revision by Dr Clavell with Medicare and supplemental insurance covering 100 % of cost for both.