Does Medicare Cover Treatment for Kidney Stones? 

Kidney stones can be some of the most uncomfortable and downright painful medical problems you can encounter. In fact, some people have claimed that pain from kidney stones is worse than that of childbirth!

Symptoms of kidney stones may include pain and pressure in the lower abdomen along with difficulty urinating or stopping and starting urination. Stones may also cause internal bleeding depending on the shape and sharpness of the stone, so you may experience blood in your urine. If your doctor suspects kidney stones, they may order imaging tests that will show the presence of stones. 

What are kidney stones?

Kidney stones are rock-like formations made up of a combination of different minerals in the body. Sodium can also contribute to the formation of kidney stones. Although all kidney stones form in the kidneys, there are different kinds of stones that can form, including:

• Cystine stones
• Struvite stones
• Stones made up of uric acid
• Calcium oxalate stones

Kidney stones generally form slowly over time as minerals build up. They are then released from the kidney and sent along one of the ureters that connects the kidneys to the bladder.

How Are kidney stones treated?

The treatment for kidney stones depends on the size of each stone and its location. Most kidney stones will pass on their own through urination. Because stones vary in size, some may be too big to easily move through the narrow ureters and can become lodged somewhere in a kidney or between the bladder and the affected kidney.

If a stone cannot be passed naturally, treatment may be required. Certain medications may help relax muscles if there is a physiological problem causing a kidney stone to stay stuck, but in most cases, the only solution is to drink water to naturally pass a stone.

In cases where a kidney stone is too large to pass or is causing an obstruction that leads to negative health outcomes, ultrasonic waves may be used to break up a large stone. If this approach is ineffective, surgery may be required.

Does Medicare cover treatment for kidney stones?

Because kidney stones can affect people of all ages, seniors are susceptible to developing kidney stones. In fact, seniors are in a demographic most at risk from negative effects of kidney stones due to the risk of infection if a stone causes bleeding.

Thankfully, Medicare benefits cover treatment for kidney stones in a few different ways, including:

Inpatient Medicare coverage for kidney stones

Inpatient treatment for kidney stones under Medicare is covered by Medicare Part A. This part of Medicare covers all medically necessary treatments ordered by a hospital or skilled nursing facility while you are admitted.

Outpatient Medicare coverage for kidney stones

Outpatient treatment for kidney stones is covered by Medicare benefits through Part B. Outpatient treatment may consist of doctor visits and ultrasonic therapy, also known as lithotripsy. Medicare benefits for outpatient kidney stone treatment pay for 80% of treatment costs, leaving Medicare recipients to cover the remaining 20%.

Medicare Part B will also cover costs associated with surgery if your doctor or specialist believes surgery to be your best option. If you require hospitalization prior to or following kidney stone surgery, this care is covered by Medicare Part A.

Prescription drug coverage for kidney stones

Medicare coverage is also available for prescription medications used in the treatment of kidney stones. These benefits are administered through Medicare Part D.

Under Medicare Part D, pain management prescriptions and muscle relaxers are usually covered for the treatment of kidney stones as long as they are prescribed by a Medicare-participating physician for a medically necessary purpose. You can check your plan’s list of covered medications, or formulary, for more information.