Does Medicare Cover Urolift? 

A man’s prostate is the gland that produces seminal fluid which helps to move sperm along the urethra during ejaculation. Prostatic fluid also nourishes sperm to keep them healthy for fertilization of a woman’s egg. The prostate is located in the pelvic region above the rectum, and it surrounds the urethra. With age, many men experience prostate enlargement naturally, but prostate enlargement can occur due to conditions like prostate cancer or benign hyperplasia (BPH).

Why prostate enlargement matters

When the prostate becomes enlarged, it can lead to pain and discomfort, infertility, difficulty urinating, urination urgency and other urological symptoms. While conditions like BPH may not be life-threatening, there is a genuine need among senior men to seek treatment for enlarged prostate symptoms. Certain medications may help along with changes to diet and exercise, but newer treatments like Urolift show promise in treating enlarged prostate conditions related to BPH.

What is Urolift?

Urolift is a prostate treatment that involves minor surgery. During the Urolift procedure, a specialist uses a device to enter a man’s body through the urethra to access the prostate. Small implants are then placed to compress the prostate, alleviating the pressure it places on the urethra. Currently, the Urolift procedure is only recommended for men who have mild BPH. It is not a treatment for prostate cancer. Your urologist or primary care physician can provide more information regarding your candidacy for the Urolift procedure.

Does Medicare cover Urolift?

In cases where your doctor believes that the Urolift procedure is medically necessary to protect your health and promote overall well-being, Medicare benefits will cover costs associated with the Urolift procedure. You will need to carry Medicare Part B coverage in order to receive outpatient coverage for Urolift. Medicare coverage for Urolift and other outpatient medical services is covered at a rate of 80%. Medicare recipients pay the remainder as a coinsurance payment.

Inpatient Medicare benefits for Urolift

Medicare Part A supplies hospital coverage for Medicare recipients. If you undergo a Urolift procedure while admitted to a Medicare-participating hospital or skilled nursing facility (SNF), the cost of the procedure may be covered by Medicare Part A benefits.

Take note that Medicare Part A only covers the cost of surgical procedures that are performed as part of a hospital stay. Many outpatient procedures are performed at hospitals and do not require admittance. These procedures are considered outpatient in nature and are therefore covered by Medicare Part B.

Medicare coverage may depend on where the procedure is performed

There’s another catch when it comes to having Urolift performed at a hospital: The doctor or specialist performing the procedure must be a part of the facility’s staff in order to receive inpatient coverage through Medicare benefits. If a doctor or specialist needs to be brought in from a separate office, Medicare recipients will potentially receive a separate bill for outpatient services. Thankfully, Medicare Part B can be used to pay for these services in the majority of cases.

Does Medicare Part D help cover medication for an enlarged prostate? 

Because Urolift is a physical procedure and not a prescription medication, Medicare Part D does not apply directly to Urolift. Even so, Medicare benefits for prescription drugs through Part D may help to pay for medications prescribed to treat prostate enlargement. Medicare does not, however, cover common supplements like saw palmetto. These supplements are sometimes used by men who experience an enlarged prostate, but Medicare coverage does not supply benefits for any non-prescription supplements.

How Medicare Advantage plans cover Urolift

Urolift should be covered by Medicare Advantage plans because these plans share the same Part A and Part B benefits as Original Medicare. Although Medicare Advantage plan providers have the option to offer additional benefits not found in Original Medicare, these additional benefits are determined by the provider and the laws of the state in which the Medicare Advantage plan is offered.