Medicare Coverage for Erectile Dysfunction (ED)
Medicare prescription drug plans don’t cover Viagra, Cialis or other medications used to treat erectile dysfunction. Injections and penis pumps aren’t covered either. Penile implant surgery is partially covered by Medicare for those who qualify.
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APA Christian, R. (2022, September 21). Medicare Coverage for Erectile Dysfunction (ED). RetireGuide.com. Retrieved October 1, 2022, from https://www.retireguide.com/medicare/treatments/erectile-dysfunction/
MLA Christian, Rachel. “Medicare Coverage for Erectile Dysfunction (ED).” RetireGuide.com, 21 Sep 2022, https://www.retireguide.com/medicare/treatments/erectile-dysfunction/.
Chicago Christian, Rachel. “Medicare Coverage for Erectile Dysfunction (ED).” RetireGuide.com. Last modified September 21, 2022. https://www.retireguide.com/medicare/treatments/erectile-dysfunction/.
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| Medicare Plan | ED Coverage |
|---|---|
| Part A (Inpatient) | N/A |
| Part B (Outpatient) | Covers 80% of penile implant surgery costs if you qualify and have reached your Part B deductible. |
| Part C (Medicare Advantage) | Most plans with prescription drug coverage don’t cover oral or injectable ED medications, but treatments may be covered for those who qualify. |
| Part D | Congress has banned coverage of medications for ED. |
| Supplemental Insurance | Can help cover out-of-pocket costs related to erectile dysfunction. Coverage varies by plan. |
Does Medicare Cover Erectile Dysfunction Treatment?
Medicare doesn’t typically cover erectile dysfunction oral medications or injections.
However, penile implant surgery is partially covered by Medicare for those who qualify.
Diagnosing erectile dysfunction, or ED, typically requires you to answer a few questions and undergo a physical exam from your doctor.
- Blood tests
- Urine tests
- Ultrasound
- Psychological exams (such as a depression screening test)
Besides penile implant surgery, therapy from a mental health professional is generally the only other treatment covered by Medicare for erectile dysfunction.
Your out-of-pocket Medicare costs to treat erectile dysfunction may be high, since prescription drugs to treat the condition aren’t covered.
ED Drugs Covered Under Medicare
Oral medications are often the first line of treatment for erectile dysfunction.
Unfortunately, Medicare generally does not cover brand-name prescription drugs used to treat erectile dysfunction, such as Viagra and Cialis.
Since 2006, Congress has banned Medicare Part D coverage of medications for erectile dysfunction.
In addition, most private Medicare Advantage plans with prescription drug coverage don’t cover oral or injectable ED medications.
These medications can be expensive without insurance. Drugs.com estimates that just two 100 milligram Viagra pills cost about $164.
However, generic versions of these drugs are now on the market for a fraction of the price.
It’s nearly always more affordable to purchase generic erectile dysfunction medications — such as sildenafil citrate, tadalafil and vardenafil — without insurance than to buy Viagra or Cialis.
For example, the average cash pharmacy price for sildenafil, the generic version of Viagra, costs about $197 for a 30-day supply, according to GoodRx.
Prescription coupons from GoodRx and similar companies can substantially reduce your out-of-pocket cost to as little as $12 to $25 a month.
Buying the generic version Generic versions of Viagra and Cialis have been around since 2017. Filling a prescription for sildenafil or similar drugs will be cheaper than buying their brand-name counterparts.
Comparison shopping Pharmacy prices vary, so the same drug may be cheaper at a different store. Certain web-based tools and apps allow you to easily compare prices.
Pill splitting Sometimes getting pills at a higher dose and cutting them in half can be cheaper per dose.
Taking advantage of manufacturer discounts or free samples You might be able to get a limited supply of medications from the manufacturer. You can ask your doctor if he or she has any free samples or free trials of ED medications.
Note that Medicare may cover sildenafil and another branded drug called Revatio when the drugs are used to treat pulmonary arterial hypertension, a serious high blood pressure condition in the lungs.
However, Medicare won’t cover these same drugs if prescribed for erectile dysfunction.
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ED Pumps Covered by Medicare
In 2015, CMS discontinued coverage for male vacuum erection systems and related accessories.
According to legislation at the time, vacuum erection devices — more commonly known as penis pumps — were excluded from Medicare coverage “in the same manner that erectile dysfunction drugs are treated in Part D.”
Medicare Advantage plans must comply with such federal decisions, so private Medicare plans likely won’t cover erectile pumps either.
Your urologist might know of pharmacies in your area where FDA-approved penis pumps are sold.
Medicare Coverage for Penile Implants
Medicare covers penile implant surgery for those who qualify.
A penile implant prosthesis is considered a medically necessary treatment for erectile dysfunction if noninvasive treatments — such as prescription drugs and injections — have been ineffective.
Your erectile dysfunction must also be the result of an organic rather than psychological cause.
Penile implants are generally not recommended until other treatment methods have been tried. The implants have a high patient satisfaction rate.
You can expect to pay between $2,500 and $3,000 out-of-pocket for penile implant surgery, according to Coloplast, a company that develops and produces medical devices related to ostomy, urology and continence.
You may owe less for this surgery if you have supplemental insurance, such as Medicaid or a Medigap policy.
If you’re enrolled in a Medicare Advantage plan, your doctor may need prior authorization before scheduling your surgery.
Penile implant procedures typically take place on an outpatient basis and are covered under Medicare Part B.
After meeting your annual Part B deductible, you will owe 20 percent for doctor services and 20 percent for any separately billed items you receive during surgery. Hospital facility fees also apply.
What Is Erectile Dysfunction?
Mayo Clinic defines erectile dysfunction, also known as impotence, as “the inability to get and keep an erection firm enough for sex.”
Symptoms of ED include trouble getting an erection, trouble keeping an erection and reduced sexual desire.
Roughly 40 percent of men ages 40 and older have difficulty getting or maintaining an erection — and the problem increases with age.
Underlying health conditions often contribute to erectile dysfunction. Other times, medications and other treatments may be necessary.
Some medications make it more difficult to keep or maintain an erection.
- High blood pressure drugs (antihypertensives)
- Antihistamines
- Antidepressants
- Parkinson’s disease drugs
- Diuretics
- Antiarrhythmics (for irregular heartbeat)
- Tranquilizers
- Muscle relaxants
- Pain pills
- Hormones
- Chemotherapy medications
- Prostate cancer drugs
- Antiseizure medications
Other risk factors that may contribute to or worsen erectile dysfunction include alcohol and tobacco use, obesity, certain injuries and psychological conditions.
