Transurethral Resection of the Prostate (TURP) is a common surgery for men dealing with benign prostatic hyperplasia (BPH) or simply an enlarged prostate. This is a condition that affects many men as they age and can cause annoying problems like difficulty urinating and the constant urge to go. So the big question here is—does Medicare cover TURP surgery? Well the short answer is yes but let’s dive deeper into what this means for your wallet and your health.
What Is TURP Surgery?
TURP surgery involves removing part of the prostate that’s blocking the flow of urine. It’s performed with a resectoscope—basically a fancy medical camera with a loop that can cut away tissue. The surgery is minimally invasive meaning it doesn’t require large incisions like some other procedures. That said you’re probably not signing up for fun; it still comes with its own risks and recovery times.
How TURP Surgery Works
- Step 1: The patient is placed under anesthesia (general or spinal)
- Step 2: A resectoscope is inserted through the tip of the penis into the urethra
- Step 3: The surgeon trims away the overgrown prostate tissue causing blockage
- Step 4: The patient is monitored for a couple of days post-surgery to ensure there are no complications
Does Medicare Cover TURP Surgery?
Yes Medicare does cover TURP surgery! But like with anything Medicare-related there are some things you’ll want to know before scheduling that procedure. TURP surgery is classified as a medically necessary treatment for BPH which falls under Medicare Part B. Since it’s an outpatient procedure you’re looking at coverage through Medicare Part B (or possibly Part A if it’s done in a hospital during an inpatient stay).
However, there will be out-of-pocket costs involved because Medicare doesn’t cover 100%.
What Will Medicare Cover?
- Surgery Costs: Medicare Part B will cover 80% of the surgery cost after you meet your yearly deductible (which in 2024 is $240). You’ll be responsible for the remaining 20%.
- Hospital Stay (if applicable): If you’re admitted to a hospital for the surgery Medicare Part A may cover the cost of the hospital stay after your deductible. Again 20% of the cost will likely fall on you.
- Anesthesia: Medicare will also cover anesthesia costs though similar rules apply regarding the 80/20 split.
- Follow-up Appointments: Most post-op visits will be covered under Part B. But again the 80/20 rule applies.
Hidden Costs You Should Consider
When it comes to TURP surgery it’s not just the cost of the procedure itself that you should think about. Let’s take a look at the extras you may not have accounted for.
Hospital vs Outpatient Costs
- Hospital Inpatient Costs: If for some reason you need to stay in the hospital for longer than expected that can add up quickly. Medicare Part A only covers up to a certain amount of hospital days after which you may end up paying more out of pocket.
- Outpatient Surgery Costs: These are lower in comparison but still don’t forget that 20% copay. On a $10,000 surgery that’s $2000 you’ll need to come up with.
Medications
After TURP surgery your doctor might prescribe medications to prevent infections or manage pain. Unfortunately Medicare Part D (which covers prescription drugs) isn’t as comprehensive as we’d all like it to be. There’s a chance you’ll end up paying for these medications on your own unless you have supplemental insurance or a good Medicare Advantage plan.
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Potential Drawbacks of TURP Surgery
While TURP surgery is effective it’s not without its downsides. Here’s a rundown of some potential drawbacks of the procedure…and let’s add a little humor to lighten the mood!
Risk of Temporary Erectile Dysfunction
Well this one’s awkward. But let’s face it the thought of experiencing erectile dysfunction post-surgery is enough to make anyone a little queasy. The good news is this is usually temporary. So try not to worry too much—you’ll be back to winking at your partner soon enough.
Urinary Incontinence
Imagine going in for surgery to fix your constant bathroom breaks only to end up needing…ahem adult diapers. Now that’s the definition of irony. But in all seriousness urinary incontinence can happen though it’s rare and usually improves over time.
Retrograde Ejaculation
This is when semen goes into the bladder instead of out of the body during ejaculation. Don’t worry it’s harmless but for most guys it’s definitely not what they were aiming for.
Should You Get TURP Surgery?
At the end of the day Henry Beltran owner of Medicare Advisors Insurance Group LLC says “You really need to weigh the pros and cons. For many men TURP surgery is a game-changer—being able to urinate without a problem and getting rid of that constant urge can improve your quality of life.” But Henry also emphasizes “Make sure you talk to your doctor about all the risks involved. Just because Medicare covers it doesn’t mean you should rush into it without understanding the full picture.”
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How to Minimize Your Out-of-Pocket Costs
No one likes surprise medical bills right? Here are a few ways to make sure you minimize the amount you pay for TURP surgery.
Look into a Medicare Supplement Plan
- Medigap plans can help cover the 20% that Original Medicare leaves you with. If you don’t have one yet this might be a good time to consider it.
Consider a Medicare Advantage Plan
- Many Medicare Advantage plans offer additional benefits that Original Medicare doesn’t—like coverage for prescription drugs post-surgery. Some even reduce out-of-pocket expenses for procedures like TURP surgery. Just make sure to read the fine print!
Check With Your Doctor
- Before scheduling surgery double-check that your doctor and the hospital are in Medicare’s network. Believe it or not some hospitals and doctors still don’t accept Medicare.
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Final Thoughts
In conclusion Medicare does cover TURP surgery but you’ll need to factor in deductibles copays and other potential out-of-pocket costs. This is where Henry’s advice comes in handy—“Make sure you know what you’re signing up for both financially and medically. Surgery isn’t a decision to take lightly.” With the right preparation and insurance coverage you can make sure TURP surgery helps you out without causing your bank account to cry for help!
If you have more questions or need assistance with your Medicare plan or Medicare Advantage options feel free to reach out to Medicare Advisors Insurance Group LLC. We’re here to help!
FAQs
What Is BPH?
BPH stands for benign prostatic hyperplasia—a fancy term for an enlarged prostate that makes it hard to urinate.
Will Medicare Cover Follow-up Visits After TURP Surgery?
Yes Medicare Part B generally covers follow-up visits.
Can I Have TURP Surgery Done as an Outpatient?
Yes TURP surgery can often be done on an outpatient basis which is covered under Medicare Part B.
