For patients considering a penile implant, one of the important questions is whether the cost is covered by Medicare. In Australia, Medicare may contribute to certain hospital and surgical expenses, but the level of cover can depend on the type of procedure, where it is performed, and whether the patient also has private health insurance. Understanding what is included and what out-of-pocket costs may still apply is an important step before making any decisions. Speaking with your urologist and checking directly with Medicare or your health fund can provide clear information about your situation.
Does Medicare Cover the Surgery?
Medicare may provide partial coverage for the surgery if the procedure is listed under an approved Medicare Benefits Schedule (MBS) item number. This means Medicare can pay a portion of the surgeon’s fee and hospital charges when the procedure is performed in a hospital setting. However, Medicare does not usually cover the entire cost.
What Costs Might Medicare Pay For?
Medicare may cover part of the surgeon’s fee and the anaesthetist’s fee. Some hospital costs may also be covered if the procedure is done in a public hospital. In a private hospital, Medicare pays a set amount, but patients usually need to pay the difference between this rebate and the full cost.
Are There Out-of-Pocket Expenses?
Yes, there are usually out-of-pocket expenses for the surgery. These can include costs for the implant device itself, private hospital fees, and any charges above the Medicare rebate. Patients are encouraged to ask for a written estimate of costs before surgery so they understand what financial contribution is required.
How Does Private Health Insurance Affect the Cost?
Private health insurance can reduce out-of-pocket costs, depending on the level of cover. Some policies will pay part or all of the hospital stay, theatre fees, and the cost of the implant device. Patients should check directly with their health fund to confirm if penile implants are included in their policy.
Does the Type of Hospital Make a Difference?
Yes. In a public hospital, the procedure may be covered by Medicare, but waiting times can be longer, and the choice of surgeon may be limited. In a private hospital, patients usually have more control over timing and choice of surgeon, but there are higher costs. Medicare still contributes in private settings, but patients need to pay the gap.
Do You Need a Referral to Access Medicare Benefits?
Yes. In Australia, patients generally need a referral from their general practitioner (GP) to see a urologist and access Medicare rebates for consultations and surgery. Without a referral, Medicare will not provide benefits.
What Medicare Item Numbers Apply to the Surgery?
The procedure may fall under specific Medicare Benefits Schedule (MBS) item numbers that relate to the surgical management of erectile dysfunction. These item numbers are used to determine what portion of the fee Medicare will cover. Patients can ask their urologist for the exact item number to confirm coverage with Medicare and their health fund.
How Can Patients Check Their Medicare Coverage?
Patients can check their coverage by contacting Medicare directly or using the MyGov online portal. They can also ask their urologist or hospital staff for the MBS item number, which makes it easier to confirm rebate amounts. Private health insurers can provide details on what they will cover once the item number is known.
Can Medicare Cover Follow-Up Appointments or Tests?
Some follow-up appointments and tests may be partially covered by Medicare if they fall under recognised item numbers. This could include consultations with the urologist or certain medical tests ordered after surgery. Patients should ask which services are eligible so they know in advance what will be billed.
What Should Patients Ask Before Proceeding With Surgery?
Before going ahead, patients should ask for a written breakdown of costs, including the surgeon’s fees, hospital charges, anaesthetist fees, and the cost of the implant device. They should also confirm what portion is covered by Medicare and private health insurance. This helps ensure there are no unexpected expenses.
Why Choose Sydney Urologist Dr Katelaris for Penile Implants
Dr Phillip Katelaris is a urological surgeon with extensive training in Australia and overseas, including postgraduate surgical training in Germany and robotic surgery training in the United States. He consults across Sydney and North Shore, with clinics in Hornsby, Castle Hill, and St Leonards, and performs procedures at Sydney Adventist Hospital.
For patients considering a penile implant, Dr Katelaris provides thorough consultations that include discussion of medical history, treatment goals, and available options. These consultations cover important aspects such as the possible risks, the recovery process, and long-term factors that may be involved. Patients are also informed about alternatives so they can compare different approaches before making a decision.
At Katelaris Urology, patients receive structured information to help them prepare for surgery and recovery. This includes guidance on pre-operative requirements, what to expect in hospital, and planning for follow-up care. By outlining each stage clearly, Dr Katelaris supports patients in understanding the steps involved in the procedure.
Further reading about penile implants with Dr Katelaris:
- Read the KU penile prosthetic surgery page
- KU blog: How to enhance your recovery after penile implant surgery?
- KU blog: Is there a recommended age for penile implant surgery?
- KU blog: How long can penile implants last?
- KU blog: Is a penile prosthesis worth it?
- KU blog: What to consider before a penis implant procedure?
- KU blog: What facts to consider about penile implants?
Medical references about penis implants:
