Is Axonics Therapy Covered By Medicare?

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As we age, our bodies can start to show signs of wear and tear. For some, this can lead to problems with urinary incontinence, which can be both embarrassing and uncomfortable. Fortunately, there are treatment options available, including Axonics Therapy. This innovative treatment has been proven effective for those suffering from urinary incontinence, but many people are left wondering whether it is covered by Medicare.

If you or a loved one is considering Axonics Therapy, it’s important to understand your coverage options. Medicare can be confusing, and it can be difficult to determine what treatments and procedures are covered. In this article, we’ll take a closer look at Axonics Therapy and explore whether it is covered by Medicare. So, if you’re tired of dealing with urinary incontinence and want to learn more about this cutting-edge treatment, read on!

Is Axonics Therapy Covered by Medicare?

Is Axonics Therapy Covered by Medicare?

Overview of Axonics Therapy

Axonics Therapy is a type of treatment for people who suffer from urinary and fecal incontinence. This therapy involves the use of a small device that is implanted under the skin and stimulates the sacral nerves to control bladder and bowel function. Axonics Therapy is a relatively new treatment, having received FDA approval in 2019. It is considered a less invasive and more effective alternative to other types of therapy, such as medication or surgery.

What is Medicare?

Medicare is a federal health insurance program that provides coverage for people over the age of 65 or those with certain disabilities. It is divided into four parts: Part A covers hospital stays, Part B covers doctor visits and outpatient care, Part C is also known as Medicare Advantage and allows beneficiaries to receive coverage through private insurance companies, and Part D covers prescription drugs.

Does Medicare Cover Axonics Therapy?

The answer to this question is not a straightforward one. Medicare considers Axonics Therapy to be an “investigational” or “experimental” procedure, which means that it is not covered under the traditional Medicare program. However, some Medicare Advantage plans may offer coverage for this treatment. Beneficiaries should check with their specific plan to determine whether or not it is covered.

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Cost of Axonics Therapy

The cost of Axonics Therapy can vary depending on several factors, including where the procedure is performed, the surgeon’s fees, and the cost of the device itself. On average, the cost of the device is around $20,000, and the entire procedure can cost up to $40,000. It is important to note that if a Medicare Advantage plan does offer coverage for this treatment, there may still be out-of-pocket costs for the beneficiary.

Benefits of Axonics Therapy

Axonics Therapy offers several benefits over other types of treatment for urinary and fecal incontinence. It is a minimally invasive procedure that can be performed on an outpatient basis, meaning that the patient can go home the same day. It also has a high success rate in reducing or eliminating symptoms of incontinence. Additionally, the device is designed to last for at least 15 years, making it a long-term solution.

Axonics Therapy vs. Other Treatments

Compared to other treatments for urinary and fecal incontinence, Axonics Therapy has several advantages. Medications used to treat these conditions can have side effects, and surgical procedures can be invasive and require a longer recovery time. Additionally, other types of therapy may not be as effective as Axonics Therapy.

How to Get Axonics Therapy Covered by Medicare

As previously mentioned, Axonics Therapy is not covered under the traditional Medicare program. However, beneficiaries may be able to receive coverage through a Medicare Advantage plan. It is important to check with the specific plan to determine whether or not it is covered. If a plan does not offer coverage, beneficiaries can contact their elected representatives to advocate for coverage of this treatment under Medicare.

Conclusion

Axonics Therapy is a promising new treatment for urinary and fecal incontinence, but it is not currently covered under the traditional Medicare program. However, some Medicare Advantage plans may offer coverage for this treatment. Beneficiaries should check with their specific plan to determine whether or not it is covered. If a plan does not offer coverage, beneficiaries can advocate for coverage of this treatment under Medicare.

Frequently Asked Questions

Here are some common questions and answers regarding Axonics Therapy and Medicare coverage.

1. What is Axonics Therapy?

Axonics Therapy is a type of treatment for overactive bladder and bowel conditions. It involves implanting a small device that delivers electrical impulses to certain nerves in the body, helping to regulate bladder and bowel function. The device is designed to be long-lasting and can be adjusted as needed to achieve the best possible results for the patient.

While Axonics Therapy is not a cure for overactive bladder or bowel conditions, it can significantly improve a patient’s quality of life by reducing symptoms such as urgency, frequency, and incontinence.

2. Is Axonics Therapy covered by Medicare?

Yes, Axonics Therapy is covered by Medicare for patients who meet certain criteria. To be eligible for coverage, patients must have a diagnosis of overactive bladder or bowel conditions that have not responded to other treatments, and they must have tried and failed to improve their symptoms with other neuromodulation therapies.

Patients who meet these criteria may be able to receive partial or full coverage for the cost of the device and the surgical implantation procedure. However, it’s important to note that coverage can vary depending on individual circumstances, so patients should consult with their healthcare provider and Medicare representative to determine their specific coverage options.

3. What is the process for getting coverage for Axonics Therapy under Medicare?

To get coverage for Axonics Therapy under Medicare, patients must first be evaluated by a healthcare provider to determine if they meet the eligibility criteria. If they do, their provider will need to submit a request for coverage to Medicare on their behalf.

Once the request has been approved, patients can schedule the implantation procedure with a qualified healthcare provider. Medicare will typically cover a portion of the cost of the device and the procedure, but patients may still be responsible for out-of-pocket expenses such as deductibles and co-pays.

4. What are the potential risks and side effects of Axonics Therapy?

Like any medical procedure, Axonics Therapy carries some risks and potential side effects. These may include infection, pain, discomfort, and bleeding at the implantation site, as well as device malfunction or failure.

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However, serious complications are rare, and most patients experience significant improvement in their symptoms with few or no side effects. Patients should discuss the potential risks and benefits of Axonics Therapy with their healthcare provider before undergoing the procedure.

5. How effective is Axonics Therapy for treating overactive bladder and bowel conditions?

Axonics Therapy has been shown to be highly effective in reducing symptoms of overactive bladder and bowel conditions. In clinical trials, up to 90% of patients experienced significant improvement in their symptoms after receiving the therapy.

Additionally, Axonics Therapy has been found to be safe and well-tolerated by most patients, with few or no side effects. However, individual results may vary depending on the severity of the patient’s condition and other factors, so it’s important for patients to discuss their specific treatment options with their healthcare provider.

As a professional writer, it is evident that the question of whether Axonics Therapy is covered by Medicare is a pressing concern for many individuals. While the answer is not straightforward, it is essential to understand that Medicare coverage for this therapy depends on various factors, such as the patient’s medical condition and the type of Medicare plan they are enrolled in.

Despite the uncertainty surrounding Medicare coverage for Axonics Therapy, it is crucial to note that healthcare providers and patients can work together to explore alternative coverage options. Patients can benefit from consulting with their healthcare provider and insurance provider to determine whether there are any other insurance plans that offer coverage for this therapy. It is evident that Medicare coverage for Axonics Therapy may be limited, but with the right resources and guidance, patients can still access the treatment they need.

Meet Rakibul Hasan, the visionary leader and founder of Freeinsurancetips. With over a decade of experience in the insurance sector, Rakibul is dedicated to empowering individuals to make well-informed decisions. Guided by his passion, he has assembled a team of seasoned insurance professionals committed to simplifying the intricate world of insurance for you.

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