Can Medicare Pay for an Implant?

[Anonymous3]

In my area CA. the going rate that some advertise is 20k. If medicare only allows $13,000.00, I see why in demand Drs do not take medicare.

That is more than likely the private pay / care credit

https://surgeo.com/Penile-Implant-South ... iLEALw_wcB

[oldbeek]

I'm in my 40s and was informed that I'm eligible for Medicare (strange but true). Presently I got Medicaid bundled with Fidelis and live in NYC. Can Medicare pay for an implant? If so which Medicare plan does pay for it, A or B?

You live in NYC with medicare, Call Dr Eid, he is the best.

[Tsanchez12369]

When you find a doc that accepts Medicare make sure they ACCEPT ASSIGNMENT. That means they cannot charge you more than the approved Medicare amount. (You still have to pay 20% of that unless you have the supplemental insurance.) If not, you also have to pay the difference between the Medicare approved amount and the private pay rate.

[Anonymous3]

I thought if they took Medicare they had to accept the assigned amount

[CTR5000]

Medicare is my primary insurance and covered 80% of everything involved in my implant... the device; my surgeon; surgical suite; and private room that night.

The balance was paid-in-full by our secondary insurance. I had no out-of-pocket expenses.

Once I hit my deductible for the year, any procedure I might need is covered this same way. But I MUST have my deductible met. I meet it by the end of January/beginning of February each year. Had I scheduled my implant surgery (or any other procedure) for sometime within the first 4 weeks of the year, I'd be running the risk of not having met that deductible and paying out-of-pocket costs.

My various medications are what put me over that deductible each year. Getting them filled within January all contributes to my deductible. A state-provided program pays for any out-of-pocket medication costs, so even in those first weeks of the year, my medications cost me nothing even though they are adding up to meet that deductible.

So, as far as my situation goes, I can't give a blanket answer without discussing that deductible.

[Zxylpk]

Medicare paid 100% for me. Total cost was over $80K. I only pay $20 co pay for office visit.

[David_R]

Medicare is my primary insurance and covered 80% of everything involved in my implant... The balance was paid-in-full by our secondary insurance. I had no out-of-pocket expenses.

Same for me.

[RayChez]

I live in California and I have a medicare advantage which was Anthem Blue Cross and they paid 100%. The hospitals and doctors are paid by what ever they are contracted with Medicare. Doctors and hospitals might send a 10K dollar bill, but if they belong to the medical group in the plan they will get what ever is in the plan, not what they want. I believe on my latest revision the total bill they got paid was around seven thousand.

[Anonymous3]

What my dr billed for everything was over 70k. Medicare assignment was 13k. They paid 10k. My secondardy paid zero. So I owe 3k

[dirtman1993]

Dr. Kramer accepts Medicare also in Baltimore