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How Much Does Medicare Pay For Prostate Surgery

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Medicare Advantage And Cancer

Does insurance cover penile implant procedures?

If you have Medicare Advantage , this means that youve purchased your Medicare plan from a private insurance company as opposed to getting it directly from the federal government. These types of plans are required to give you the same basic coverages as Original Medicare, but the CMS warns that they can have different rules and costs. Therefore, its important to go through your individual plan so you understand what it says regarding cancer coverage specifically. And if any portion of that policy is unclear, follow up with your policys administrator so you know what is covered and what isnt.

Is Prostate Removal Covered By Medicare

Medicare covers prostate surgery and other possible treatments for prostate cancer just as it does treatments for other cancers. That means inpatient services, possibly including surgery, are covered by Medicare Part A, and outpatient treatments, for example, radiation, are covered by Medicare Part B.

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Gerald Chodak, MD

Hello. I am Dr. Gerald Chodak, for Medscape. We have seen countless articles that discuss outcomes associated with radical prostatectomy in terms of complications and good results. What we do not hear much about is cost. What does it cost to have a radical prostatectomy? How variable are those costs?

Pate and colleagues published a report several months ago addressing that question. They conducted a telephone survey of 100 US hospitals using a script, the surveyor posed as a potential patient asking about the facility fee and the physician fee for radical prostatectomy. About 30% of hospitals could not provide that information, but of the 70% that could, the information was quite variable. The cost for the procedure ranged from a high of $135,000 to a low of about $10,000. Physician fees varied from $4000 up to about $19,000. The average cost for a physician or for a surgeon was about $8000. It is interesting to note that Medicare allows under $1700 for the procedure and pays 80% of that. Either the patient or co-insurance would pay the difference. There is obviously a big disconnect between the amount being charged and the amount being reimbursed. Many insurance companies tailor their reimbursement rates to the Medicare fee schedule.

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Doing It In The Us May Not Be Possible For Me

Remember that you get only one prostate operation, so you want the best.

I have medicare and a bluecross supplimenti notice that the various doctors that I saw ask more than what they accept thru these I think that you might be able to negotiate..check out a few docs for price.

As far as dr ahleringAt a support group, I spoke with a physician who had the operation with him, and asked for a professional discount//////he did not receive it

What other countries are you considering for an operation, israel, austraila , taiwan, etc

Where are you from in the US, do you have a support group and a place to stay?

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For Colorectal Cancer Medicare Covers A Traditional Screening Colonoscopy And Other Preventative Tests Including:

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  • A colonoscopy every 10 years for most people and once every 24 months if youre considered high-risk for colon cancer.
  • A fecal occult blood test every year at no additional cost if youre age 50 or older, and your doctor accepts Medicare.
  • A screening barium enema every 24 months, if youre age 50 or older and at a high risk for colorectal cancer, or every 48 months if this test is used instead of a flexible sigmoidoscopy or traditional colonoscopy.
  • A multi-target stool DNA lab test once every three years if youre age 50 to 85, show no symptoms of colorectal disease and are considered being of average risk for developing colorectal cancer.

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Options In Hormone Therapy

Testosterone levels in the body can be reduced either surgically or with drugs. The surgical option is castration, achieved by removing the testicles during a bilateral orchiectomy. Once the only option, it has since been supplanted by drugs that lower testosterone levels to amounts achieved by surgery.

For men, normal testosterone levels range from 300 to 1,000 ng/dl. The FDA requires that any new drug used in hormone therapy for prostate cancer lower testosterone levels to 50 ng/dl or less. In my practice, I usually try to lower levels even further, to 20 ng/dl.

Medicare Coverage For Holep

I have aligned myself with a top-notch surgeon for the HoLEP procedure. I know this surgery is the latest and greatest for BPH and I am excited that I have finally come to an end to my misery.

The one thing I have to get clear in my mind is Medicare coverage

. I got so caught up with the medical explanation that I clearly forgot to mention the “bill”. I know that Medicare covers hospital and surgical expences and the Group that I am seeing has all my insurance info on file.


0 likes, 33 replies

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Does Medicare Cover Chemotherapy

Yes, Medicare will cover chemotherapy if you have cancer. Medicare Part A provides coverage if youre a hospital inpatient, and Part B will provide coverage if you receive chemotherapy in a hospital outpatient setting, doctors office or freestanding clinic.

If you receive chemotherapy as an outpatient, the location where you get treatment impacts how much you pay. In a hospital outpatient setting, you will have a copayment. For chemo given in your doctors office or a freestanding clinic, youll pay 20 percent of the Medicare-approved amount and will also be responsible for the Part B deductible.

Medicare Part D plans may also cover some chemotherapy treatments and related prescription drugs. Part D plans may cover the following cancer drugs: anti-nausea drugs, oral prescription drugs for chemotherapy, pain medication or other drugs used as part of your cancer treatment.

What Are My Options For Cancer Treatment

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What type of cancer treatment your doctor choses depends on what type of cancer you have and how advanced it is. In the United States there are many options for cancer treatment according to the NIH including:

  • Surgery to remove cancer cells from the body
  • Radiation therapy to kill cancer cells and shrink tumors
  • Chemotherapy which uses medications to kill cancer cells
  • Immunotherapy which can make it easier for the immune system to fight and destroy cancer cells

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Coverage For Screening Options

While the American Cancer Society does not recommend routine testing for prostate cancer for all men, the ACS does support legislation ensuring men have insurance coverage for prostate cancer screening exams. The two most common screening tests are prostate-specific antigen testing and digital rectal exam . Your doctors and other healthcare providers should offer information on the potential risks and benefits of these tests.

Many states provide coverage for annual testing for men, age 50 and over, and for high-risk men, age 40 and over. In terms of prostate cancer, high risk refers to African American men and/or men with a family history of the disease. Some states have slightly different coverage requirements check with your insurance provider or with your state insurance commissioners office to see whats covered.

At this time Medicare covers the PSA and DRE once a year for all men with Medicare age 50 and over. There is no co-insurance and no Part B deductible for the PSA test. For other services, the beneficiary would pay 20 percent of the Medicare-approved amount after the yearly Part B deductible.

Medical recommendations for care, insurer coverage for tests and laws on coverage vary from state to state and may change, so check with your insurer or with your state insurance commissioners office to see whats covered.

Continued Below

Why Choose India For Enlarged Prostate Surgery

Medically known as benign prostatic hyperplasia , prostate enlargement is a condition in which produces similar signs and symptoms as that of prostate cancer. However, the two conditions are not related to each other and occur due to entirely different reasons. Enlargement of the prostate occurs due to the non-cancerous growth of cells around the prostate gland. As a result, the prostate grows in size and produces symptoms similar to that of prostate cancer, for example, frequent urination and pain while urinating.

Enlarged Prostate treatment in India can be availed at any major multi-specialty or urology hospital. This treatment falls under the urology specialty since in males the urinary system and the reproductive system are closely linked. Many patients from around the world travel thousands of miles to seek prostate enlargement treatment in India. This is primarily because of the low cost of medical treatment and the accessibility of quality treatment. Moreover, there is practically no waiting time for patients who travel all the way from other countries to India.

Lyfboat makes it easy for you to get quality medical opinions and find the right healthcare providers in India for enlarged prostate treatment at the best prices.

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What Is The Biggest Disadvantage Of Medicare Advantage

Medicare Advantage can become expensive if you’re sick, due to uncovered copays. Additionally, a plan may offer only a limited network of doctors, which can interfere with a patient’s choice. It’s not easy to change to another plan. If you decide to switch to a Medigap policy, there often are lifetime penalties.

Which Part Of Medicare Will Cover Prostate Cancer Screenings

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Medicare is split into four parts to help better organize billing and coverage limits. Each part will pay for different medical treatments, including:

  • Part A Covers your inpatient services like hospital stays and any associated medical or tests
  • Part B helps pay for outpatient services like doctors offices and tests done there
  • Part C Allows private insurers to offer coverage through the Medicare program
  • Part D covers prescription drugs and vaccines, some medical equipment

Depending on whether you get your diagnosis as an inpatient or outpatient, its likely that Part A and B will help pay for your prostate exam cost. In addition, if you have a cancer diagnosis, you can get Medicare genetic testing coverage, as it will be deemed medically necessary as well.

If you have Part C coverage, you may even get further savings. This depends on the private insurance company, which can sometimes be more expensive.

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Neoadjuvant And Adjuvant Hormone Therapy For Early

Hormone therapy is sometimes given in conjunction with a definitive prostate cancer treatment, such as radiation therapy, in order to improve health outcomes. When hormone therapy is given in advance of a primary treatment, its known as neoadjuvant therapy when its given during or after a primary treatment, its known as adjuvant therapy.

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Can You Ask For An Mri Scan

You can easily refer yourself for an MRI scan by completing our online form. Simply tell us about the reason you want the scan, the part of the body that you want scanned and answer some safety questions. Once received, we will then review and contact you directly to discuss and book your appointment.

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Does Medicare Cover Wigs

Although Medicare has traditionally provided a number of medical treatment benefits related to cancer, it has consistently fallen short is with regard to the hair loss many cancer treatment patients experience. More specifically, it has never helped with the cost of purchasing a wig. However, some U.S. legislators are hoping to change that. On June 15, 2017, Rep. James P. McGovern introduced a bill that would amend title XVIII of the Social Security Act to include wigswhat the bill refers to as medically necessary cranial prosthesesas durable medical equipment under the Medicare program. If this bill passes, cancer patients with Medicare could get some or all of their wig-related expenses covered or reimbursed.

Will Medicare Pay For A Psa Test

Cost of prostrate removal surgery | The Health Budget

You pay nothing for your yearly PSA blood test if your doctor accepts Medicare assignment. If your doctor accepts assignment, this means he or she agrees to accept the Medicare-approved amount as full payment for covered services.

A PSA test or digital rectal exam are not the same thing as a prostate biopsy. We recommend speaking with your doctor or health care provider about specific costs and to find out if your biopsy will be covered.

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Best Medicare Advantage Companies For Cancer

AARP/UnitedHealthcare Medicare Advantage plans have the best overall benefits for cancer patients because they provide a reasonably low cap on your medical expenses for an affordable monthly cost.


Find Cheap Medicare Plans in Your Area

Among national insurers, coverage options can vary widely by location, so you’ll need to look closely at the plans offered in your area to identify which companies offer low out-of-pocket maximums.

You may also have access to regional insurance companies, which offer a good spending cap. For example, HealthTeam Advantage in the Greensboro area of North Carolina has an average spending cap of $3,450 for its $0 Medicare Advantage plans, which is a very good value.

How Much Does Medicare Pay For Prostate Surgery

The only other thing I was drinking in the first 6 months after my diagnosis was green tea. I would drink about 4 glasses of green tea daily to go along with the increased water intake. I wasnt putting any other liquid into my body for the first 6 months. This was a big help in starting my road to recovery.

Once I started feeling better then I added organic soy milk to my diet as well. Soy milk isnt much like regular milk but once you get used to it then its not bad at all. To this day these are the only 3 liquids I have in my diet. To recap the 3 liquids I drink today are purified water,green tea,& organic soy milk. I put no other liquids into my body period.

Now, I want to chat a little more about meat & other aspects of a proper diet. As I said we dont need meat to live. I thought cutting or limiting meat in my diet would be to hard to accomplish. Well again my thinking was wrong. Was it easy? No! However, after a couple weeks then things were starting to get easier. I didnt cut all meats out of my diet but I did cut certain meats & eat moderate amounts of all others.

One meat that needs to be completely cut or at least very minimized is red meat . Too much Red meat consumption is not good for prostate health. I was eating a lot of fast food burgers & also red meat at home. I will say to at least cut red meat completely out of your diet until you get your prostate health back.

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Medicare Prescription Drug Coverage For Cancer Treatment

Medicare Part B may cover limited prescription drugs, including some cancer prescription drugs taken by mouth that may be administered to you. You also may be covered for anti-nausea drugs to treat symptoms caused by chemotherapy cancer treatment. In these situations, you usually pay 20% of the Medicare-approved amount, after the annual Medicare Part B deductible is applied. If youre admitted to a hospital, Medicare Part A typically covers prescription drugs given to you as part of your inpatient cancer treatment.

For medications that arent covered under Original Medicare, youll need Medicare Part D coverage, or you may have to pay the full cost of those prescription drugs. You can get this optional coverage through a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan. Keep in mind that not every cancer treatment medication is covered by each Medicare Prescription Drug Plan or each Medicare Advantage Prescription Drug plan. Check the formulary of the plan you have or are considering to see if the medications you need are included. A plans formulary may change at any time. You will receive notice from your plan when necessary.

Its important to review your prescription drug coverage every year, as Medicare Part D Prescription Drug Plans and Medicare Advantage Prescription Drug plans can make formulary and cost changes that affect how much you pay.

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Read Real Stories Of Men Who Underwent Treatment Of Enlarged Prostate At New York Urology Specialists

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We offer treatment for prostate problems, including slow urine stream, frequent urination at night, difficulty emptying the bladder, and other problems to patients within driving distance to our offices as well as from other states and countries. Our patients come from New York, New Jersey, Pennsylvania, Connecticut, and over 70 countries worldwide.

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Prostate Cancer Screening Tests

Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

CIM 50-55


A. General

Section 4103 of the Balanced Budget Act of 1997 provides for coverage of certain prostate cancer screening tests subject to certain coverage, frequency, and payment limitations. Medicare will cover prostate cancer screening tests/procedures for the early detection of prostate cancer. Coverage of prostate cancer screening tests includes the following procedures furnished to an individual for the early detection of prostate cancer:

  • Screening digital rectal examination and
  • Screening prostate specific antigen blood test

B. Screening Digital Rectal Examinations

Screening digital rectal examinations are covered at a frequency of once every 12 months for men who have attained age 50 . Screening digital rectal examination means a clinical examination of an individual’s prostate for nodules or other abnormalities of the prostate. This screening must be performed by a doctor of medicine or osteopathy of the Act), or by a physician assistant, nurse practitioner, clinical nurse specialist, or certified nurse midwife and §1861 of the Act) who is authorized under State law to perform the examination, fully knowledgeable about the beneficiary’s medical condition, and would be responsible for using the results of any examination performed in the overall management of the beneficiary’s specific medical problem.

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