These include pacemakers, defibrillators, joint replacements and other devices that are surgically implanted during a stay in hospital. There are often a number of different choices available with any particular prosthesis, which can vary in cost and benefits.
As from October 31, 2005, the Department of Health and Aging has set a Prosthesis List with the majority as "No Gap". You and your surgeon will be able to choose a prosthesis for every Medicare procedure from the prosthesis list that will be fully covered by ACA Health.
Other, more expensive prostheses may be available for your surgery, but if you agree to have one of these, you will have to pay the gap amount.
The new arrangements will ensure that you will still continue to have access to safe and clinically effective prostheses that are fully covered by ACA Health, while helping to ease the pressure on premiums.
1.Before you have any surgery, check with ACA Health that you will be covered.
2. If your surgery requires a prosthesis, ask your surgeon which one will be the best one for you and which no-gap prostheses are available.
3. If the surgeon recommends a prosthesis for which a gap is payable, ask why this one is being recommended. You will only have to pay part of the prosthesis cost if you agree to have one of those devices.
4. Ask the surgeon to explain the costs of the surgery, including the prosthesis gap payment (if any) and any other expenses involved. If there are any gaps for you to pay, ask for a written cost estimate.
5. Contact ACA Health again to confirm if your surgery will result in any gap payments.