Does Medicare Cover Kidney Stones?
This article was updated on: 10/06/2018
According to the National Kidney Foundation, about half a million people go to the hospital each year with kidney stones. If you have Medicare and you’ve ever suffered with this painful condition, here’s what you should know about Medicare coverage for kidney stone treatment.
What are kidney stones?
The Mayo Clinic describes kidney stones as mineral and salt deposits that form hard masses, or stones, in your kidneys and urinary tract. There is no single cause for kidney stones, but dehydration, specific types of diets, genetic factors, and certain medical conditions may put you at greater risk for developing them.
There are several types of kidney stones:
- Calcium stones, which are the most common, and tend to be related to dietary issues and metabolic disorders.
- Struvite stones, typically related to a urinary tract infection.
- Uric acid stones, which can occur in people who don’t have enough fluid in their bodies.
- Cystine stones, which are generally caused by hereditary disorders.
What is the most common type of kidney stone treatment?
If you’re wondering how to treat kidney stones, the answer depends on the size and type of the stone, and what caused it. In some cases, kidney stone removal is recommended, while in others, medications and lifestyle changes may be all that is needed.
The Mayo Clinic describes the following types of kidney stone treatment your doctor may suggest in addition to, or in place of, kidney stone removal.
Smaller kidney stone removal
Most small stones don’t cause severe pain or other symptoms. You may just need to drink extra water to flush your urinary tract, take over-the-counter medications for pain, and possible prescription drugs to relax your ureters so you can pass the stone.
Large kidney stone removal
Sometimes, large stones can’t be passed on their own, even with extra fluids, or they may be causing obstruction or damage to your urinary tract. In these cases, your doctor may use one or more procedures to help with kidney stone removal. The most common procedures include:
- Extracorporeal shock wave lithotripsy, or ESWL. This is actually a noninvasive treatment that uses sound waves to break up the stone into tiny pieces so that it can be more easily passed in your urine. It can be painful, depending on size and the location of the stone, so you may be given IV medication to keep you comfortable during the procedure.
- Surgery for kidney stone removal. If the kidney stones are very large, you may need surgery, called nephrolithotomy, to remove them. After you’re anesthetized, the doctor passes instruments to remove the kidney stones through an incision in your back.
Prevention is actually one of the best ways to treat kidney stones. Your doctor may suggest lifestyle changes or certain prescription medications to help prevent kidney stones from forming.
How does Medicare cover kidney stones?
Medicare generally covers all medically necessary kidney stone treatment your doctor recommends. Your doctor visits, lab and imaging tests, and outpatient procedures are covered under Part B. Medicare pays 80% of the allowable charges after you’ve met your Part B deductible. If you get kidney stone treatment as an inpatient in the hospital, Part A covers your costs after you meet your Part A deductible.
Unfortunately, most prescription medications used to treat kidney stones aren’t covered under Original Medicare (Part A and Part B), unless you get them as a hospital inpatient. Prescription drugs you take at home aren’t covered unless you have a Medicare Part D Prescription Drug Plan. You can get Medicare Part D coverage through a stand-alone Part D Prescription Drug Plan to go alongside Original Medicare or through a Medicare Advantage plan with prescription drug coverage. With a Medicare Advantage plan, you must continue to pay your Part B premium. You may have a deductible and copayment or coinsurance amount with your Part D coverage for prescription drugs.
Need more information about Medicare and how to treat kidney stones?
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