Does Medicare Cover a Visit to a Urologist? 

Urological issues don’t come up in casual conversations, but it’s incredibly important for seniors to discuss urological concerns with their doctors. According to the American Society of Nephrology, urological problems rank third in terms of medical complaints among seniors seeking medical intervention. Additionally, over 40% of all doctor visits by seniors are for urological symptoms.

While some urology symptoms may be merely irritating and inconvenient, others can indicate more serious conditions like cancer. This is why seniors are encouraged to speak with their doctors at the first sign of trouble.

What urological symptoms affect seniors the most?

Seniors can be affected by a range of urological symptoms, including bladder control problems and urinary tract infections. Urinary tract infections are more common in women, but both genders can be affected. Additionally, urinary incontinence affects women more than men, but men are faced with prostate concerns with age. Prostate enlargement, often due to conditions like benign prostatic hyperplasia (BPH), can cause difficulty with urination in men as well as urinary urgency and increased frequency of urination.

How are urological concerns treated?

Treatment for urological problems can range from medication support to surgery. Because the seriousness of urological symptoms can range from mildly annoying to potentially fatal, the first step in treating urological problems is to schedule a visit with your primary care physician or a urologist. Diagnostic testing will typically be ordered to investigate further, and your urologist will be able to provide you with available options.

Does Medicare cover a visit to a urologist?

Seniors experiencing concerns regarding urological problems will be happy to know that Medicare benefits pay for visits with a urologist. Medicare Part B, the outpatient portion of Medicare coverage, pays for 80% of office visits, exams and diagnostic testing. In order for a visit with a urologist to qualify, your care provider must accept assignment from Medicare. 

How much does Medicare pay for urology office visits?

Medicare Part B covers 80% of outpatient care costs, leaving 20% to be paid as a coinsurance by Medicare recipients. Inpatient urology care, or care administered while you are admitted to a hospital or skilled nursing facility, is fully covered for up to 60 days in a hospital or 20 days in a skilled nursing facility each benefit period. If, however, a urologist is not on staff at your inpatient care facility and needs to be brought in from a local urology practice, Medicare Part B will apply toward this care visit.

During your office visit with a urologist, you may be prescribed medications for your symptoms. Medicare Part D covers prescription drugs that you purchase on your own from a pharmacy for use at home. You must opt into Medicare Part D, and the cost of your medications depends on your plan’s coverage. Although Medicare Part D plans typically cover common drugs, you may need to file a waiver for approval if you are prescribed a medication that is not included in your Part D formulary.

Do Medicare Advantage plans cover visits to a urologist?

You can also receive Medicare coverage for urological care if you have a Medicare Advantage plan. These plans vary in what they offer based on plan provider and state, but all Medicare Advantage plans provide the same benefits found in Original Medicare.

This means that visits with a urologist are still covered at 80% under the Medicare benefits of Part B, but you may have to visit urologists within your plan’s network. If you belong to an HMO, you may have to get a referral from your primary care physician before seeing a specialist. 

To learn more about what options are available in your area, contact an independent Medicare insurance broker who can impartially shop plans from a number of providers.