Is PAE Covered by Medicare?
Fair Square Medicare

Is PAE Covered by Medicare?

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By Daniel Petkevich

Nov 23, 2022

Good news, you're covered

Over half of men over 50 will have to deal with an enlarged prostate. Although it's not cancerous, an enlarged prostate can be uncomfortable and disruptive. But with PAE (prostate artery embolization), you can treat an enlarged prostate without potentially impacting your sexual health. And the good news is it's covered by Medicare. Read more to find out if this treatment could be right for you.

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What is PAE?

PAE is a minimally invasive procedure that uses sophisticated imaging technology to identify the artery supplying blood to the prostate. During the procedure, a tiny hole is punctured in the groin, and a catheter is put through the artery towards the prostate. Tiny particles called emboli are injected into this artery, reducing the flow of blood and causing the enlarged prostate to shrink. The procedure takes about 1 to 4 hours

It is unlikely that you will get instant symptom relief from the procedure, but after 1 to 2 months, you might start to notice symptom relief. Within 5 to 6 months you should see the full impact realized.

Who is a good candidate for PAE?

PAE is an effective treatment for benign prostatic hyperplasia (BPH), otherwise known as an enlarged prostate. This minimally invasive procedure targets only the artery supplying blood to the prostate and doesn’t impact sexual health as other treatments do. While this condition is not cancerous, it can cause frequent urination, difficulty starting or stopping the flow of urine, and a weak urinary stream. PAE may be recommended for individuals who want to avoid taking medications for their condition, or those whose symptoms aren’t responding to medication.

What are the benefits of PAE?

PAE offers several advantages over other treatments for an enlarged prostate. It’s minimally invasive, meaning there’s no need for surgery or general anesthesia. And because the procedure targets only the artery supplying blood to the prostate, it doesn’t impact sexual health as other treatments do. Because of these benefits, PAE is a popular treatment option for BPH.

Medicare Coverage of PAE

PAE is an FDA-approved treatment that is covered by Medicare. But how does your coverage work? Your PAE will be covered by Part B, assuming you've got a recommendation from your doctor. PAE is typically an outpatient procedure, so it's unlikely you will have to deal through Part A or Part D. As a reminder, your total costs will be covered 80% by Medicare, and you will be responsible for the remaining 20%. For coverage of that 20%, you should enroll in Medicare Supplement Plan G.

What are the side effects of PAE?

The side effects of PAE are generally mild and temporary. Some patients may experience a burning sensation when urinating or some bleeding from the puncture site in the groin. In rare cases, fever, infection and urinary retention can occur. Speak with your doctor about any side effects that you may experience after the procedure.

Conclusion

If you are seeking treatment for an enlarged prostate, Medicare has your back. Talk to your doctor to see if the treatment is right for you. This content is for informational purposes only. And to make sure you're on the right Medicare plan, talk with an expert at Fair Square Medicare today.

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Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.


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