Does Medicare Cover a Vasectomy?
- Vasectomies are a highly effective, low-risk birth control procedure that hundreds of thousands of men get each year. Find out if Medicare covers vasectomies.
Around half a million men get vasectomies as a form of birth control annually. The procedure stops sperm from entering into semen, preventing pregnancy, and it involves cutting the vas deferens, which are the tubes that sperm travels along from the testicles to the urethra. It’s generally considered a form of permanent sterilization.
In most cases, vasectomies aren’t used to treat an underlying medical condition. Because of this, they’re considered elective procedures, and Medicare doesn’t cover them. However, there may be other options.
What Parts of Medicare Might Cover a Vasectomy?
Vasectomies are considered elective surgeries, meaning it’s a surgery you’re electing — or choosing — to have. It’s not a surgery necessary to treat a medical condition.
Medicare pays only for services considered to be medically required. It does not pay for elective surgeries, and that includes vasectomies and vasectomy reversals. This also applies to all sterilizations, with the exception being procedures required to treat an underlying health condition.
Medicare Advantage, or Medicare Part C, may offer vasectomy coverage. Medicare Advantage plans are required to have the same coverage as Medicare Part A and Part B, and often times these plans include additional coverage. It’s possible that vasectomies are covered by your specific Medicare Advantage plan, but you’ll need to check your plan for more details.
Part D and Medigap
There are also Medicare Part D and Medigap plans, but it’s important to note that Part D plans only cover prescription drugs while Medigap plans still only cover the original services that Medicare Part A and Part B cover.
What Deems a Vasectomy Medically Necessary?
In most cases, vasectomies are elective surgeries. These procedures are almost always used for sterilization — very rarely are they necessary for other underlying health conditions.
How Much Is a Vasectomy Out of Pocket?
The average cost for a vasectomy in the U.S. is between $300 and $3000. This fee usually covers the initial consultation, the actual procedure and the follow-up visit.
Vasectomy costs are affected by multiple factors, including where you live, the type of facility that’s performing the procedure, the type of vasectomy required and how much care you need before, during and after the procedure.
It’s also important to note that there are two types of vasectomy procedures: A conventional vasectomy, which uses a scalpel, and a no-scalpel vasectomy. However, the costs for these are usually the same, but be sure to ask your doctor about the procedures.
Another consideration is that costs may differ significantly based on where the procedure is performed. Also, keep in mind that complications of the procedure may lead to unexpected costs.
Tips for Saving
If you’re using insurance or a Medicare Advantage plan that covers vasectomies, make sure the doctor performing the procedure is within your plan’s network. You’ll pay far less by remaining in-network.
If you’re paying out of pocket, inquire about payment options. Some doctor’s offices have plans available that will allow you to make regular payments rather than pay upfront. Many providers also offer a cash discount for people who are paying for procedures themselves.
Alternatives to a Vasectomy
Since vasectomies are elective procedures intended for sterilization, there are a number of alternatives available, including temporary contraceptives such as:
- Diaphragms for women
- Birth control and hormonal treatment for women
Each method varies in effectiveness, but all are viable alternatives to a vasectomy procedure. They’re also good alternatives for individuals or couples who may want to consider children at a later time.